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Gastrointestinal System


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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S6_F1.jpg"}},{"insert":"\n\n"},{"insert":"It is already Sunday night, and you sigh as you realize that your \u0022free\u0022 weekend is almost over.\n\nAs a consolation, you decide to treat yourself to a pizza and a glass of wine at Moretti\u0027s, which lies just around the corner.\n\nAs you enter the cozy Italian pizzeria, the owner, Mrs. Moretti (who is in her early forties) welcomes you with a smile.\n\nThe pizza, as usual, is delicious.\n\nAs you pay the check and prepare to leave, Mrs. Moretti lingers by your table for a moment.\n\n\u0022I really didn\u0027t want to trouble you doctor, but I\u0027ve been having some problems recently ....\u0022\n\nShe states that she has been experiencing mild abdominal pain and nausea \u0022every now and then\u0022, for a couple of months, and was wondering if it might be \u0027gastritis\u0027.\n\nYou ask her to meet you at your clinic next week.\n"}]}

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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S6_F2.jpg"}},{"insert":"\n\n"},{"insert":"The following week, Mrs Moretti arrives at your office.\n\nYou immediately notice that she appears to be in discomfort.\n\nShe states that she experienced another episode of pain just last night, which lasted for almost 5 hours.\n\nThe pain was dull and cramping in nature, was located in the right upper quadrant of her abdomen, and radiated to her upper back.\n\nUpon further questioning, she states that the previous episodes of pain were far milder, and only lasted for a couple of hours at most, before resolving spontaneously.\n"}]}

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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S6_F3.jpg"}},{"insert":"\n\n"},{"insert":"Her vitals are significant for a blood pressure of 148\/96 mmHg , a pulse rate of 108 bpm, and a temperature of 98.7 \u00b0F (37.1 \u00b0C).\n\nExamination of the abdomen reveals tenderness and guarding in the right upper quadrant, along with a positive Murphy\u0027s Sign.\n\nThere is no organomegaly; nor are there signs suggestive of free fluid.\n"}]}

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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S6_F4.jpg"}},{"insert":"\n\n"},{"insert":"You order routine investigations including a liver profile, and request an ultrasound scan of the abdomen.\n\nAn ECG is also obtained, but is completely normal.\n\nThe investigations are significant for slightly elevated transaminase levels (AST: 60 U\/L, ALT: 72 U\/L); all other biochemical and hematological investigations are within normal parameters.\n\nThe ultrasound scan reveals features suggestive of acute cholecystitis, along with multiple small gallstones inside the gallbladder.\n\nYou realize that surgical intervention is indicated.\n"}]}

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{"ops":[{"insert":"Which surgical procedure will you employ?\n"}]}
1. Laparoscopic cholecystectomy
2. Open cholecystectomy

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