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A 25-year-old woman with no known medical history presents Intermittent RUQ pain after
to urgent care with intermittent right upper quadrant (RUQ) eating, lasting minutes
pain. In the past 2 weeks, she has had several episodes of pain consider biliary colic
after eating, which last for a few minutes. Today, she had an
episode of severe RUQ pain with nausea, which resolved after
30 minutes. She takes no medications.
Normal vitals, exam, and
Vitals are normal. Abdominal exam is unremarkable. Lab labs are reassuring against
studies, including a CBC, lipase, and hepatic panel, are normal. acute cholecystitis
Ultrasound of the RUQ shows gallbladder stones without ductal
dilatation. RUQ ultrasound shows
gallstones without evidence
What is the best next step in management? of cholecystitis
Cholelithiasis
Stone in gallbladder
Choledocholithiasis
Stone in common bile duct
ERCP = endoscopic
Jaime retrograde cholangiopancreatography, MRCP = magnetic resonance cholangiopancreatography
Miranda, Jaimetnt@live.com.mx
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Symptoms of Cholelithiasis
• Management:
• Asymptomatic observation
Types of gallstones:
1. Cholesterol/mixed: associated
with female gender, advanced
age, North/South American
indigenous populations
© 2015 Weerakoon
Jaime et al, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390354/figure/pone.0121537.g001/,
Miranda, Jaimetnt@live.com.mx CC BY 4.0, no changes
A 25-year-old woman with no known medical history presents Intermittent RUQ pain after
to urgent care with intermittent right upper quadrant (RUQ) eating, lasting minutes
pain. In the past 2 weeks, she has had several episodes of pain consider biliary colic
after eating, which last for a few minutes. Today, she had an
episode of severe RUQ pain with nausea, which resolved after
30 minutes. She takes no medications.
Normal vitals, exam, and
Vitals are normal. Abdominal exam is unremarkable. Lab labs are reassuring against
studies, including a CBC, lipase, and hepatic panel, are normal. acute cholecystitis
Ultrasound of the RUQ shows gallbladder stones without ductal
dilatation. RUQ ultrasound shows
gallstones without evidence
What is the best next step in management? of cholecystitis
A 25-year-old woman with no known medical history presents Intermittent RUQ pain after
to urgent care with intermittent right upper quadrant (RUQ) eating, lasting minutes
pain. In the past 2 weeks, she has had several episodes of pain consider biliary colic
after eating, which last for a few minutes. Today, she had an
episode of severe RUQ pain with nausea, which resolved after
30 minutes. She takes no medications.
Normal vitals, exam, and
Vitals are normal. Abdominal exam is unremarkable. Lab labs are reassuring against
studies, including a CBC, lipase, and hepatic panel, are normal. acute cholecystitis
Ultrasound of the RUQ shows gallbladder stones without ductal
dilatation. RUQ ultrasound shows
gallstones without evidence
Answer: referral for elective cholecystectomy of cholecystitis
A 31-year-old man with no past medical history presents to the RUQ pain with fever,
ED with 2 days of RUQ pain accompanied by fever, nausea, nausea, vomiting > 6 hours
and vomiting. Over the last few months, he has had intermittent in duration with history of
abdominal pain after eating. These episodes last for a few biliary colic
minutes, then resolve.
Fever, tachycardia
Vitals are notable for temperature of 38.2°C (100.8°F) and
heart rate of 115/min. On abdominal exam, he has tenderness Exam and labs localize to
to palpation in the RUQ, but no rebound tenderness or biliary system
guarding. Lab studies show mild elevation in AST, ALT, and total
bilirubin. Abdominal ultrasound shows pericholecystic fluid and Ultrasound findings are
gallbladder wall thickening. concerning
• Physical exam:
causing pain)
RLQ LLQ
1. Pericholecystic fluid
3. Gallstones
4. Sonographic sign
©2013 MazzeiJaime
et al; licensee
Miranda,BioMed Central Ltd., Figure 3, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711740/figure/F3/, CC BY 2.0,
Jaimetnt@live.com.mx
edited
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Acute Cholecystitis
1. Pericholecystic fluid
3. Gallstones
4. Sonographic sign
©2013 MazzeiJaime
et al; licensee
Miranda,BioMed Central Ltd., Figure 3, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711740/figure/F3/, CC BY 2.0,
Jaimetnt@live.com.mx
edited
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© www.lecturio.com | This document is protected by copyright.
Acute Cholecystitis
1. Pericholecystic fluid
3. Gallstones
4. Sonographic sign
Percutaneous cholecystostomy
© by Lecturio Jaime Miranda, Jaimetnt@live.com.mx
A 31-year-old man with no past medical history presents to the RUQ pain with fever,
ED with 2 days of right upper quadrant (RUQ) pain nausea, vomiting > 6 hours
accompanied by fever, nausea, and vomiting. Over the last few in duration with history of
months, he has had intermittent abdominal pain after eating. biliary colic
These episodes last for a few minutes, then resolve.
Fever, tachycardia
Vitals are notable for temperature of 38.2°C (100.8°F) and
heart rate of 115/min. On abdominal exam, he has tenderness Exam and labs localize to
to palpation in the RUQ, but no rebound tenderness or biliary system
guarding. Lab studies show mild elevation in AST, ALT, and total
bilirubin. Abdominal ultrasound shows pericholecystic fluid and Ultrasound findings are
gallbladder wall thickening. concerning cholecystitis
A 31-year-old man with no past medical history presents to the RUQ pain with fever,
ED with 2 days of right upper quadrant (RUQ) pain nausea, vomiting > 6 hours
accompanied by fever, nausea, and vomiting. Over the last few in duration with history of
months, he has had intermittent abdominal pain after eating. biliary colic
These episodes last for a few minutes, then resolve.
Fever, tachycardia
Vitals are notable for temperature of 38.2°C (100.8°F) and
heart rate of 115/min. On abdominal exam, he has tenderness Exam and labs localize to
to palpation in the RUQ, but no rebound tenderness or biliary system
guarding. Lab studies show mild elevation in AST, ALT, and total
bilirubin. Abdominal ultrasound shows pericholecystic fluid and Ultrasound findings are
gallbladder wall thickening. concerning cholecystitis
• Diagnosis:
• Diagnosis:
Common
bile duct
Gallstones
If a gallstone blocks both the common bile duct and the pancreatic duct,
this leads to gallstone pancreatitis.
© by Lecturio Jaime Miranda, Jaimetnt@live.com.mx
Guidewire
Duodenoscope
Wire-guided
sphincterotomy
Impacted
gallstone
Fever
Fever
triad pentad
Altered
Hypotension mental
RUQ pain Jaundice status
3. Broad-spectrum IV antibiotics
• β-lactam/β-lactamase inhibitor
diagnose different gallbladder disorders.
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