Here are the initial lab results:
Complete your diagnostic work up:
What is the next best diagnostic test in this case?
Magnetic resonance cholangiopancreatography (MRCP)
Incorrect. MRCP can help better evaluate the hepatopancreaticobiliary system. It is superior to ultrasound for detecting stones in the cystic duct (sensitivity 100 versus 14 percent). However, it is not the first test recommended in patients suspected to have cholecystitis or choledocholithiasis. Try again!
Correct! As a first line, a RUQ US is a quick non-invasive test, to detect cholecystitis or biliary dilation. RUQ US has a sensitivity of 88% and specificity of 80% for acute cholecystitis. And 84% and 99% respectively for the detection of gallstones.
Incorrect. While HIDA scan has a sensitivity of >90% and specificity of 70-90% for diagnosing acute cholecystitis, it is not as reliable for diagnosing choledocholithiasis. Given the elevated bilirubin and alkaline phosphatase in this patient, choledocholithiasis should be considered on the differential. Try again!
Incorrect. While CT Abdomen (especially with pancreas protocol) can help diagnose pancreatitis, cholecystitis and biliary tree pathologies. However, a RUQ US would be a quick, non-invasive initial test for our patient. Also, given the normal lipase and atypical features of pain, pancreatitis is now much lower on the differential. Try again!
Endoscopic retrograde cholangiopancreatography (ERCP)
Incorrect. The role of ERCP is largely limited to performing therapeutic interventions in the hepatopancreaticobiliary system. While it can be used for diagnostic purposes, there are other non-invasive diagnostic tests that carry fewer risks of complications. Try again!
Endoscopic Ultrasound (EUS)
Incorrect. While EUS can be used for diagnostic purposes in hepatobiliary pathology, there are other non-invasive diagnostic tests that carry fewer risks of complications. Try again!
Click here to move on!