MKSAP: 41-year-old woman with burning epigastric and chest pain

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 41-year-old woman is evaluated in follow-up after presenting to the emergency department 1 week ago for burning epigastric and chest pain. In the emergency department, a complete blood count and liver chemistry studies were normal, but a radiograph of the chest and upper abdomen demonstrated calcified gallstones. The pain resolved with administration of a liquid antacid, and omeprazole was started. The pain had been present intermittently for approximately 6 months prior to the emergency department visit. It occurred nearly every day, usually after meals and when recumbent, and had been typically burning in nature at night. The pain has not recurred since she started omeprazole. She has not had dysphagia and has a good appetite and stable weight. Her medical history is notable for obesity. On physical examination, vital signs are normal; BMI is 36. There is no abdominal tenderness, and the liver and spleen are of normal size. Murphy sign is negative. Which of the following is the most appropriate management for this patient’s gallstones? A. Annual ultrasonography B. Laparoscopic cholecystectomy C. Ursodiol D. Clinical observation Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Gastroenterology Source Type: blogs