Diagnosis: Acute calculous cholecystitis with choledocholithiasis
Our patient presented with acute onset right upper quadrant abdominal pain and jaundice. The differential and work up to be considered for this symptom complex is reviewed below. RUQ ultrasound is a quick, non-invasive, and inexpensive modality for testing and recommended as the first diagnostic step. Likelihood of having choledocholithiasis can be assessed based on the predictors described by the ASGE guidelines. MRCP and EUS are more sensitive than RUQ US for detecting hepatobiliary pathology. ERCP is the procedure that enable therapeutic interventions such as clearing the biliary tree of sludge and stones, sampling of any biliary stricture/mass, and biliary drainage. Patients with acute cholecystitis should be treated with antibiotics and planned for cholecystectomy.
Case authored by: Chip Bowman-zamora MD and Bhavana Bhagya Rao MD
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