Master the board step 3

Master the Boards: USMLE Step 3
Diagnostic Testing
Diagnose with a CBC and a contrast CT of the abdomen/pelvis.
Treatment
··
Always drain an intra-abdominal abscess (either surgically or percutaneously).
··
Give antibiotics to prevent spread of infection (does not cure abscess).
Surgical Jaundice
Obstructive Jaundice Caused by Stones
The question will describe an obese, fecund woman in her 40s with the following
signs:
··
Recurrent episodes of abdominal pain
··
High alkaline phosphatase
··
Dilated ducts on sonogram
··
Nondilated gallbladder full of stones
··
Direct hyperbilirubinemia
Basic Science Correlate
The common hepatic duct and cystic duct merge to form the common bile
duct, which merges with the pancreatic duct and allows enzyme and bile
exit through the sphincter of Oddi.
ERCP and EUS are never
the first step in diagnosis.
ERCP is most often a
management step on the
exam.
Diagnostic Testing
1. Order a sonogram.
2. Confirm with endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography
(MRCP).
Treatment
1. Perform endoscopic retrograde cholangiopancreatography (ERCP) with
sphincterotomy.
2. Cholecystectomy should follow.
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