A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth. Two days later the patient presented with jaundice, dark urine. Objectively: sclera and skin are icteric, abdomen is swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner's, Kehr's, Murphy's, Zakharyin's, Mayo-Robson's symptoms are positive. Which method should be applied for diagnosis in the first place?

Answer options

1. USI of gallbladder and biliary duct
2. X-ray of abdominal organs
3. Fibrogastroduodenoscopy
4. Radionuclide scanning of liver and gallbladder
5. Diagnostic laparotomy

Explanation

A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth. Two days later the patient presented with jaundice, dark urine. Objectively: sclera and skin are icteric, abdomen is swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner's, Kehr's, Murphy's, Zakharyin's, Mayo-Robson's symptoms are positive. Which method should be applied for diagnosis in the first place? Ortner’s, Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s signs are positive in acute cholecystitis. USG is gold-standard for the hepatobiliary disorder.