Difference between revisions of "Symptomatic cholelithiasis"

(History)
 
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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
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[[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

  • 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).

Management

Disposition

  • Discharge

See Also

References