RUQ Abdominal Pain

There are 5 key diagnoses classically associated with right upper quadrant (RUQ) abdominal pain. Cholelithiasis and Biliary Colic * Cholelithiasis = Gallstones in the gallbladder* Frequently seen on CT scan or RUQ ultrasound* Present in 15% of the population* Biliary colic = Intermittent episodes of pain if stone passes* Classically colicky/crampy/spasmy pain in RUQ* Frequently radiates to right shoulder/flank* Pain is intermittent and resolves after a few hours* Patients need pain control and outpatient follow up with general surgery Cholecystitis (Inflammation of the Gallbladder) * Caused by obstruction of the cystic duct* Increased pressure in the gallbladder results in ischemia/inflammation* Diagnosis* RUQ Ultrasound* Gallbladder wall thickening* Pericholecystic fluid* Cholelithiasis* CT of the abdomen and pelvis also has decent sensitivity/specificity* Admit for cholecystectomy Choledocolithiasis (Common Bile Duct Obstruction) * Terminology* Cholecystitis = Stone in CYSTIC DUCT* Choledocolithiasis = Stone in COMMON BILE DUCT* Symptoms similar to cholecystitis* Testing* LFTs will be elevated* Results from blockage of bile outflow from liver* RUQ Ultrasound* Shows dilation of the common bile duct* Treatment* GI Consult* Endoscopic Retrograde Cholangiopancreatography (ERCP) Cholangitis (Infection of Bile Duct/Liver) * Common complication of choledocolithiasis* Charcots triad* RUQ pain* Fever* Jaundice* Reynolds pentad* RUQ pain* Fever* Jaundice* Altered mental status* Shock/hypotension* Treatment* Fluids* IV antibiotics* ERCP Gallstone Pancreatitis * Gallstone obstructs PANCREATIC DUCT* Testing* Lipase will be elevated* LFTs will be elevated* RUQ will show dilation of the CBD* Treatment* Fluids* Pain medicine* ERCP Additional Reading * Biliary Diseases and Pancreatitis (EM Clerkship)* Biliary Anatomy (TeachMeAnatomy)