Emergency Medicine - RUQ Pain

Question 1

What are you looking for with a HIDA scan (5)?

Answer 1

Liver uptake (normal)
 Excretion into duodenum  
Filling of the gallbladder
  Function of the gallbladder   
Biliary tract leaks

Question 2

Roll of morphine with HIDA Scan?

Answer 2

Morphine induces sphincter of Oddi contraction. If the gallbladder still doesn’t fill, it suggests acute cholecystitis.

Question 3

Role of CCK administration?

Answer 3

Assess the gallbladder ejection fraction in cases of suspected chronic cholecystitis - identify if administration reproduces patient pain.

Question 4

Why do you order a CT scan in a case with RUQ Pain?

Answer 4

Rule out intra-abdominal causes of pain aside from cholecystitis (especially in the face of normal RUQ Sonogram and HIDA).

Question 5

Sign on CT (or sonogram) indicative of emphysematous cholecystitis?

Answer 5

Air in the wall of the gallbladder.

Question 6

What is the first test of choice for patients complaining of cholecystitis symptoms?

Answer 6

RUQ Sonogram

Question 7

What is the diagnostic gold standard for patients complaining of cholecystitis symptoms?

Answer 7

HIDA Scan.

Question 8

When should percutaneous drainage of the gallbladder be considered?

Answer 8

In very ill or high risk patients.

Question 9

If a patient presents with 5+ days of cholecystitis symptoms, when should surgery be preformed?

Answer 9

Patients could be allowed to “cool down” (inflammatory changes) and return approximately 6 weeks later for definitive operative treatment.