Image of the Month—Quiz Case | Hepatobiliary Disease | JAMA Surgery | JAMA Network
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Special Feature
Oct 2011

Image of the Month—Quiz Case

Author Affiliations


Author Affiliations: Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Athens, Greece.

Arch Surg. 2011;146(10):1213. doi:10.1001/archsurg.2011.263-a

A 27-year-old woman was admitted on an emergency basis, with acute pain in the right upper abdominal quadrant and nausea and vomiting for the previous 3 days. Her medical history was normal. On physical examination, she was dehydrated, with a positive Murphy sign and mild fever. Blood cell count was normal. Results of blood chemistry demonstrated a mild hyperbilirubinemia (total bilirubin level: 1.8 mg/dL and direct bilirubin level: 1.6 mg/dL [to convert both to micromoles per liter, multiply by 17.104]) and mildly elevated alkaline phosphatase (150 U/L [to convert to microkatals per liter, multiply by 0.0167]) and γ-glutaminotranspeptidase (105 U/L) levels.