218.A 42-year-old woman (5 ft, 3 in., 170 lb) complains of sudden onset
of severe pain in the right upper abdomen “under the ribs” accompanied by
sweating, nausea, and a feeling of imminent collapse. The pain lasts for
about 2 hours and then persists as a dull ache. When seen several hours
later, she has normal bowel sounds, is tender throughout the abdomen,
especially in the right upper quadrant, and is faintly icteric. She has noticed
her urine is darker than usual but has not passed stool recently. She recalls
occasional episodes of “indigestion” referred to the right upper abdomen
and radiating to the shoulder. This has occurred especially after eating fried
foods or after eating a meal following a long period of fasting. She has no
fever but is anxious and tachycardic. The test results available are a blood
count and blood chemistry including liver enzymes, alkaline phosphatase,
and bilirubin. She has a WBC of 10,000. Her cellular hepatic enzymes are:
AST/SGOT=52 (normal 3–33) and ALT//SGPT =70 (normal 4–44), alka-
line phosphatase =300 (normal 17–91), bilirubin =6.3 (normal 0.2–1.0).
Which of the following is the most probable diagnosis?
a. Hepatitis A
b. Hepatitis B
c. Carcinoma of the head of the pancreas
d. Gallstone obstructing common bile duct
e. Biliary cirrhosis
Gastrointestinal Tract and Glands 325