Symptomatic cholelithiasis: Difference between revisions
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===Diagnosis | ==Background== | ||
==Diagnosis== | |||
#History | #History | ||
##RUQ pain that is constant, lasts 1-5hr, and then remits | ##RUQ pain that is constant, lasts 1-5hr, and then remits | ||
###Pain >5hr suggests cholecystitis, cholangitis, or pancreatitis | ###Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]] | ||
##Usually does not occur during fasting | ##Usually does not occur during fasting | ||
#Physical Exam | #Physical Exam | ||
| Line 8: | Line 10: | ||
#Labs | #Labs | ||
##LFT, CBC normal | ##LFT, CBC normal | ||
#Ultrasound | #[[RUQ Ultrasound]] | ||
##Sensitivity 84%, Specificity 99% | ##Sensitivity 84%, Specificity 99% | ||
===Treatment | ==Differential Diagnosis== | ||
#IV/IM | {{DDX RUQ}} | ||
==Treatment== | |||
#IV/IM ketorolac (as effective as meperidine) with Rx for Ibuprofen | |||
==See Also== | |||
*[[Gallbladder Disease (Main)]] | |||
==Source== | ==Source== | ||
Revision as of 03:18, 27 October 2014
Background
Diagnosis
- 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
- RUQ pain that is constant, lasts 1-5hr, and then remits
- Physical Exam
- Often benign; as compared to cholecystitis, usually negative Murphy's Sign
- Labs
- LFT, CBC normal
- RUQ Ultrasound
- Sensitivity 84%, Specificity 99%
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
Treatment
- IV/IM ketorolac (as effective as meperidine) with Rx for Ibuprofen
See Also
Source
- UpToDate
- Tintinalli