RUQ pain Flashcards
Distinguish biliary colic, acute cholecystitis and ascending cholangitis in terms of pain, fever and jaundice?
Colic: Intermittent pain
Cholecystitis: Persistent pain + fever
Ascending cholangitis: Persistent pain + fever + jaundice
How can acute cholangitis and ascending cholangitis be distinguished from Primary sclerosing cholangitis and primary biliary cirrhosis?
ACs: Fever
PC: Itching
Who is likely to get biliary colic?
Fat, females, forties and fertile
Inspiratory arrest on RUQ pain indicates what?
Acute cholecystitis
RUQ pain, fever and jaundice associated with hypotension and confusion indicates what?
Ascending cholangitis
What is the investigation and management of biliary colic?
Ix: US shows acoustic shadowing
Rx: Elective cholecystectomy
What is the investigation and management of acute cholecystitis?
Ix: US, HIDA if unsure
Rx: IV antibiotics + cholecystectomy within a week
What is the investigation and management of ascending cholangitis?
Ix: Ultrasound
Rx: IV antibiotics + ERCP 24-48 hours later
What is the cause of ascending cholangitis?
Infection (E. Coli) due to stagnant bile collecting
What cause of RUQ pain is highly associated with UC?
Primary sclerosing cholangitis
due to p-ANCA
Raised AMA-M2 and igM indicates which cause of RUQ pain?
Primary biliary cirrhosis
Which RUQ pain cause shows a ‘beaded appearance on ERCP?
PSC
What is the first line investigation for primary biliary cirrhosis
US to exclude obstruction
How do you treat PSC and PBC?
Both: Cholestyramine for itch PSC: Liver transplant PBC 1st: urso GS: transplant
What RUQ pain cause is associated with skin and joint changes?
Primary biliary cirrhosis
Jaundice with RUQ pain and mass raises suspicion of what cause?
Cholangiocarcinoma
What nodes can you examine for if cholangiocarcinoma is suspected?
Periumbilical
Left supraclavicular
What clinical features help distinguish pancreatic cancer from cholangiocarcinoma
Pancreatic cancer is painless or epigastric
Greasy stool and diabetic symptoms may occur
What are the first line and gold standard investigations for cholangiocarcinoma and pancreatic cancer?
Both: US first line
Cholangio: MRCP/ERCP then CT
Pancreatic: High resolution CT
what is the tumour marker pancreatic cancer?
CA 19-9
What surgical options are there for bile gallbladder and pancreatic cancer?
GC: Cholecystectomy
PC: Whipple’s
