NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Figure 7-5: Intraoperative cholangiogram showing distal obstruction due to a retained stone.

A high-quality cholangiogram is mandatory with biliary pancreatitis. Noninvasive imaging such as magnetic resonance cholangiopancreatog- raphy (MRCP) (Fig. 7-6) may be preferred because ERCP is associated with inducing pancreatitis in a small percentage of patients. SAMPLE Q: How would the proposed management change if the patient appears ill secondary to acute pancreatitis? A: If the patient has significant complications from the pancreatitis, such as high fluid requirements, hypocalcemia, oliguria, hypotension, or pulmonary complications, it is necessary to delay the cholecystectomy . If there is dilated CBD or a stone in the distal duct, then consideration of ERCP is appropriate because of the probabil- ity of distal bile duct obstruction. Relieving the obstruction is important for rapid recovery.

Case 7.7 Right Upper Quadrant Pain with High Fever

A 60-year-old has marked RUQ pain and gallstones on ultrasound examination. There is a temperature of 104°F and a blood pressure (BP) of 100/60 mm Hg.