Difference between revisions of "Symptomatic cholelithiasis"

(History)
 
Line 5: Line 5:
 
==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
Line 19: 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
**LFT, CBC normal  
+
**[[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

Gallbladder anatomy
  • 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

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).

Management

Disposition

  • Discharge

See Also

References