Symptomatic cholelithiasis: Difference between revisions

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===Diagnosis===
==Background==
# History
{{Gallbladder background}}
## RUQ pain that is usually constant, not colicky
{{Gallbladder disease types}}
## Usually does not occur during fasting
# Physical Exam
## Often benign; as compared to cholecystitis, usually negative Murphy's Sign
# Labs
## LFT, CBC normal
# Ultrasound
## Sensitivity 84%, Specificity 99%


===Treatment===
==Clinical Features==
# IV/IM Ketorolac (as effective as meperidine) with Rx for Ibuprofen
===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
*Radiation to the right shoulder increases likelihood, but is not sensitive
 
===Physical Exam===
*Often benign; as compared to cholecystitis, usually negative Murphy's Sign
 
==Differential Diagnosis==
{{DDX RUQ}}
 
==Evaluation==
[[File:StonesXray.png|thumb|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]
*Labs
**LFT, CBC normal
*RUQ Ultrasound
**Sensitivity 84%, Specificity 99%
 
==Management==
*IV/IM [[ketorolac]] vs. [[morphine]]
**Prescription for [[ibuprofen]] or [[opioid]]
 
==Disposition==
*Discharge


==See Also==
==See Also==
*[[Gallbladder Disease (Main)]]
*[[Gallbladder Disease (Main)]]
*[[Ultrasound: Gallbladder]]
*[[Biliary ultrasound]]
 
==References==
<references/>


[[Category:GI]]
[[Category:GI]]

Revision as of 03:06, 2 October 2018

Background

Anatomy & Pathophysiology

  • Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
  • These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
  • Bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.

Gallbladder disease types

Gallbladder anatomy (overview).
Gallbladder anatomy

Clinical Features

History

  • RUQ pain that is constant, lasts 1-5hr, and then remits
  • Usually does not occur during fasting
  • Radiation to the right shoulder increases likelihood, but is not sensitive

Physical Exam

  • Often benign; as compared to cholecystitis, usually negative Murphy's Sign

Differential Diagnosis

RUQ Pain

Evaluation

Gallstones found incidentally on KUB (xrays are not sensitive).
  • Labs
    • LFT, CBC normal
  • RUQ Ultrasound
    • Sensitivity 84%, Specificity 99%

Management

Disposition

  • Discharge

See Also

References