Just finished reading an article on Health section of New York Times, in which a story of an old lady almost died from taking a small pill for her leg cramps. The physicians managed to save her but the actual culprit was found after carefully history retaking. It does not need any tests at all.
It remind me of a patient which was admitted for jaundice yesterday. I ask a brief history of jaundice and other constituted symptoms. I think it should be a simple of obstructive jaundice. What is surprise me it diagnosis is acute hepatitis, which in fact, not wrong at all, with the ALT raised to 700++. But, I found it not really fit into the patient presenting history of severe pain at epigastric for past 2 years, which likely due to gallstone. Further, recent hepatitis B/C screening were negative and patient had denied promiscuity.
Patient had an urgent U/S and bingo, it’s indeeds a case of choledocholithiasis.
It’s a case of listen what patient said and arrive a diagnosis.