Mukund

So he is cared for by an inpatient team, but he lives in the emergency department.

And unfortunately, for a few days, he ends up living in the hallway of an emergency department.

So the study that I'm really sure you're hoping for a paracentesis isn't done yet.

It has to be done in a more protected environment than a hallway.

So

It's deferred to slightly later in the admission.

So I'm sorry, you won't be getting that yet.

A HIDA scan is done, which shows non-visualization of the gallbladder.

And the read is, this may reflect cholecystitis in the appropriate setting.

However, the study was prematurely boarded due to patient tolerance.

A second study is done, a right upper quadrant ultrasound with Doppler, which is completed and shows cirrhotic liver, no focal liver lesions.

Distended gallbladder with layering sludge.

Wall thickening may be reactive in the setting of volume overload.

Ascites.

Negative sonographic Murphy's sign.

And patent portal venous and hepatic venous systems.

With this data, which is very gallbladder focused, I'm wondering how your differential diagnosis changes and how you weight gallbladder inflammation against some of the many other really interesting things you've put on the differential diagnosis.

Really, really pleased with this discussion.

I think this one is going to break the case wide open because I'm giving you the study that you so desperately wanted, the paracentesis.

So finally, after two days in the hospital, I do a paracentesis and the results are almost immediately very shocking.