A 41-year-old woman is brought in by her family to the emergency department because of an acute onset of right upper quadrant pain, nausea and vomiting. Clinicians believe that the common bile duct may be responsible for her presentation.

Which of the following statements is true regarding the common bile duct?

A 56-year-old alcoholic man presents to the emergency department with confusion and lethargy. On physical examination, he is visibly jaundiced with ascites. Laboratory investigations reveal increased prothrombin time (PT) and prolonged activated partial thromboplastin (aPTT) time, as well as significantly increased ammonia levels.

Which of the following physical examination findings would you MOST LIKELY expect to see?

A 20-year-old male is undergoing endoscopy for investigation of a recent history of diarrhoea with bloody stool, abdominal pain and weight loss. The gastroenterologist found pancolitis with friable and erythematous tissue extending from the rectum and throughout the colon. She also noted mild mucosal inflammation of the distal ileum.

Which of the following diagnoses is most consistent with the patient’s presentation?

A 67-year-old lady presents to ED with a 1 day history of RUQ abdominal pain, nausea and vomiting. She has no significant past medical history and does not drink alcohol. On examination, she is Murphy’s positive. Her WCC is elevated at 12.5 and her CRP is raised at 21. Her bilirubin is normal and her LFTs are not deranged. She also has a normal lipase and amylase.

Which investigation would be of MOST value in order to guide management for this patient?

A 78-year-old gentleman presents to ED with painless bright red PR bleeding. He estimates approximately 200ml of blood in the past 2-3 bowel motions. He reports no pain during defecation. Your PR examination reveals no haemorrhoids and no obvious masses on palpation. He had an empty rectum with no blood visible on the glove.

What would be the MOST LIKELY diagnosis for this patient?

A 65-year-old lady presents with a 1 month history of tiredness, progressive lethargy and increasing pain in the epigastrium. She has lost approximately 10kg in weight. Over the last 5 days, she has noticed her urine has been dark and frothy. Her faeces have been pale in colour. Despite her weight loss, she is obese and no abnormalities are found on examination of the abdomen.

An abdominal US is the next investigation of choice.

Which one of the following is MOST LIKELY to be shown by the US?

A 42-year-old man with hepatosplenomegaly and a history of alcoholic cirrhosis presents after vomiting fresh blood on 5 occasions. He is diaphoretic, pulse rate is 120 beats per minute and his BP is 100/60, dropping to 85/45 on sitting upright.

After haemodynamic stabilisation of the patient, which one of the following investigations is MOST important afterwards?

You are caring for a patient with acute necrotising pancreatitis who is developing worsening sepsis and organ failure despite maximal intensive care and broad-spectrum antibiotic administration 12 days after the onset of pancreatitis. You obtain a percutaneous, CT-guided fine needle aspirate of his pancreatic necrosis that demonstrates bacterial infection.

What is the MOST APPROPRIATE management for the patient now?

Which statement is CORRECT in patients with severe acute pancreatitis?