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Chapter 7 ♦ Pancreatic and Hepatic Disorders

the best treatment is resuscitation, antibiotics and emergent ERCP with sphincterotomy, decompression of the biliary tree, and stone removal if fea- sible (Fig. 7-8). If this is not successful, there are two options: 1. A transhepatic cholangiogram and stone extraction, which may be performed by an interventional radiologist OR 2. If this procedure is not successful, CBD drainage with a t-tube is required. Figure 7-8: ERCP showing a distal common bile duct obstruction due to a stone ( S ) and extraction of the stone. (From Yamada T, Alpers DH, Owyang C, et al. Textbook of Gastroenterology , 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999:2723.) SAMPLE Case 7.8 Right Upper Quadrant Pain in an Extremely Ill Older Adult A 78-year-old who presented to the emergency department with a 12-hour history of RUQ pain and tenderness has been admitted. The patient appears quite ill.