Symptomatic cholelithiasis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===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 | ||
*Radiation to the right shoulder increases likelihood, but is not sensitive | |||
===Physical Exam=== | ===Physical Exam=== | ||
| Line 18: | Line 19: | ||
[[File:StonesXray.png|thumb|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]] | [[File:StonesXray.png|thumb|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]] | ||
*Labs | *Labs | ||
** | **[[LFTs]], CBC normal | ||
*RUQ Ultrasound | *[[RUQ Ultrasound]] | ||
**Sensitivity 84%, Specificity 99% | **Sensitivity 84%, Specificity 99% | ||
Latest revision as of 04:16, 30 September 2019
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
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- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Acute calculous cholecystitis
- Ascending cholangitis
- Acalculous cholecystitis
- Biliary atresia
- Cholestasis of pregnancy
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
- 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
- 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
Evaluation
Gallstones found incidentally on KUB (xrays are not sensitive).
- Labs
- LFTs, CBC normal
- RUQ Ultrasound
- Sensitivity 84%, Specificity 99%
Management
Disposition
- Discharge