Gallbladder disease (main)

DDX

1. Cholecystitis
2. Cholangitis
3. Symptomatic Cholelithiasis

Cholangitis

Diagnosis

1. Charcot's Triad: Fever + jaundice + RUQ pain
   1. Occurs in 50-75%
2. Reynold's Pentad: The triad + AMS + hypotension
   1. Hypotension may be the only presenting sign in elderly pts
3. Labs
   1. Leukocytosis with neutrophil predominance
   2. Elevated alk phos, conj. bilirubin
   3. Blood culture is indicated
4. Imaging
   1. Ultrasound
      1. Dilatation of CBD ( > 6mm) and presence of choledocholithiasis
      2. May miss small CBD stones and in acute cases CBD may not have had time to dilate
5. ERCP
   1. Should be obtained to confirm the diagnosis and to intervene

Treatment

1. Broad-spectrum parenteral Abx covering gram - and anerobes
   1. CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)

Symptomatic Cholelithiasis

Diagnosis

1. History
   1. RUQ pain that is usually constant, not colicky
   2. Usually does not occur during fasting
2. Physical Exam
   1. Often benign; as compared to cholecystitis, usually negative Murphy's Sign
3. Labs
   1. LFT, CBC normal
4. Ultrasound
   1. Sensitivity 84%, Specificity 99%

Treatment

1. IV/IM Ketorolac (as effective as meperidine) with Rx for Ibuprofen

See Also

Ultrasound: Gallbladder

Source

UpToDate