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There are 5 key diagnoses classically associated with right upper quadrant (RUQ) abdominal pain.

Cholelithiasis and Biliary Colic

  • Cholelithiasis = Gallstones in the gallbladder
    • Frequently seen on CT scan or RUQ ultrasound
    • Present in 15% of the population
  • Biliary colic = Intermittent episodes of pain if stone passes
    • Classically colicky/crampy/spasmy pain in RUQ
      • Frequently radiates to right shoulder/flank
      • Pain is intermittent and resolves after a few hours
    • Patients need pain control and outpatient follow up with general surgery

Cholecystitis (Inflammation of the Gallbladder)

  • Caused by obstruction of the cystic duct
    • Increased pressure in the gallbladder results in ischemia/inflammation
  • Diagnosis
    • RUQ Ultrasound
      • Gallbladder wall thickening
      • Pericholecystic fluid
      • Cholelithiasis
    • CT of the abdomen and pelvis also has decent sensitivity/specificity
  • Admit for cholecystectomy

Choledocolithiasis (Common Bile Duct Obstruction)

  • Terminology
    • Cholecystitis = Stone in CYSTIC DUCT
    • Choledocolithiasis = Stone in COMMON BILE DUCT
  • Symptoms similar to cholecystitis
  • Testing
    • LFTs will be elevated
      • Results from blockage of bile outflow from liver
    • RUQ Ultrasound
      • Shows dilation of the common bile duct
  • Treatment
    • GI Consult
    • Endoscopic Retrograde Cholangiopancreatography (ERCP)

Cholangitis (Infection of Bile Duct/Liver)

  • Common complication of choledocolithiasis
  • Charcots triad
    • RUQ pain
    • Fever
    • Jaundice
  • Reynolds pentad
    • RUQ pain
    • Fever
    • Jaundice
    • Altered mental status
    • Shock/hypotension
  • Treatment
    • Fluids
    • IV antibiotics
    • ERCP

Gallstone Pancreatitis

  • Gallstone obstructs PANCREATIC DUCT
  • Testing
    • Lipase will be elevated
    • LFTs will be elevated
    • RUQ will show dilation of the CBD
  • Treatment
    • Fluids
    • Pain medicine
    • ERCP

Additional Reading