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Part IV ♦ Gastrointestinal Disorders

IV. Treatment: A. Clearance of biliary tree: Via ERCP, percutaneous transhepatic cholangiography (PTC), or common bile duct exploration. B. Cholecystectomy: Removes source of current and future stones. V. Prognosis

A. Good with clearance. B. Can lead to cholangitis.

TRUSTED SOURCE Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Clinical Spotlight Review: Management of Choledocholithiasis . Available at https://www. sages.org/publications/guidelines/clinical-spotlight-review-management-of- choledocholithiasis

CHOLANGITIS I. Etiology

A. Ascending infection of the bile ducts. B. Associated with obstruction due to stones or benign/malignant stricture. C. E . coli is most common organism. II. Clinical presentation: A. Charcot triad: Fever, jaundice, RUQ pain. B. Reynolds pentad: Fever, jaundice, RUQ pain, hypotension, altered mental status. III. Diagnosis: Labs and imaging. IV. Treatment: A. Antibiotics and intravascular volume resuscitation. B. Relief of obstruction: ERCP (preferred), PTC, or surgical exploration. V. Prognosis: Mixed, depending on degree of sepsis.

CUT TO CASEBOOK See NMS Surgery Casebook , 3rd edition, Case 7.7: Right Upper Quadrant Pain with Fever.

BILIARY DYSKINESIA I. Etiology: Motility disorder that affects the gallbladder and sphincter of Oddi. II. Clinical presentation: Postprandial RUQ pain. III. Diagnosis: HIDA scan showing gallbladder EF <35%. IV. Treatment: Laparoscopic cholecystectomy. V. Prognosis: Excellent.