Symptomatic cholelithiasis: Difference between revisions
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==Background== | ==Background== | ||
== | ==Clinical Features== | ||
===History=== | |||
*RUQ pain that is constant, lasts 1-5hr, and then remits | |||
**Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]] | |||
*Usually does not occur during fasting | |||
===Physical Exam=== | |||
*Often benign; as compared to cholecystitis, usually negative Murphy's Sign | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Diagnosis== | |||
*[[File:StonesXray.png|thumb|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]] | |||
*Labs | |||
**LFT, CBC normal | |||
*[[RUQ Ultrasound]] | |||
**Sensitivity 84%, Specificity 99% | |||
==Treatment== | ==Treatment== | ||
*IV/IM [[ketorolac]] vs. [[morphine]] | |||
**Prescription for [[ibuprofen]] or narcotic | |||
==Disposition== | |||
*Outpatient management | |||
==See Also== | ==See Also== | ||
*[[Gallbladder Disease (Main)]] | *[[Gallbladder Disease (Main)]] | ||
== | ==References== | ||
==See Also== | ==See Also== | ||
Revision as of 05:08, 21 May 2015
Background
Clinical Features
History
- RUQ pain that is constant, lasts 1-5hr, and then remits
- Pain >5hr suggests cholecystitis, cholangitis, or pancreatitis
- Usually does not occur during fasting
Physical Exam
- Often benign; as compared to cholecystitis, usually negative Murphy's Sign
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Diagnosis
Gallstones found incidentally on KUB (xrays are not sensitive).- Labs
- LFT, CBC normal
- RUQ Ultrasound
- Sensitivity 84%, Specificity 99%
Treatment
Disposition
- Outpatient management