Gallstones/ Cholidocholithiasis/ Acute cholangitis
SUMMARY
Symptoms
80% asymptomatic. If so, no rx required.
Biliary colic
Fat, Female, Fair, Forty, Fertile
Signs
Acute cholangitis
Bloods: FBC+CRP (acute cholangitis), LFT (obstructive picture for acute cholangitis)
Imaging: US (stones/ acute cholangitis duct dilation), ERCP (CBD stones), MRCP (not therapeutic, CBD stones), PTC (if ERCP fails)
Management
Symptoms
80% asymptomatic. If so, no rx required.
Biliary colic
- Steady, severe, dull RUQ pain, radiating to R shoulder/ scapula, worse with fatty food
- (Jaundice)
- RUQ pain
- Jaundice
- Dark urine, pale stools
- Charcot's triad: RUQ pain, fever, jaundice
- n+v
- ileus
Fat, Female, Fair, Forty, Fertile
Signs
Acute cholangitis
- Reynold's pentad: RUQ pain, fever, jaundice, confusion, shock
- Abdo distension
Bloods: FBC+CRP (acute cholangitis), LFT (obstructive picture for acute cholangitis)
Imaging: US (stones/ acute cholangitis duct dilation), ERCP (CBD stones), MRCP (not therapeutic, CBD stones), PTC (if ERCP fails)
Management
- Analgesia, rehydration
- Gallstones: Elective lap cholecystectomy/ Lithotripsy
- CBD stone/ acute cholangitis: AbERCP/ PTC, + cholecystectomy
Source
OHCM 9th Ed 2014
Toronto Notes 2012
OHCM 9th Ed 2014
Toronto Notes 2012