RUQ Abdominal Pain

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 13 August 2017

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

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Summary

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

* Biliary Diseases and Pancreatitis (EM Clerkship)* Biliary Anatomy (TeachMeAnatomy)

Transcript

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0:00.0	Hello, med students. My name is Zach Olson, and thank you for downloading this week's
0:06.8	episode of the EM Clerkship Podcast. Bear with me if there's a little bit of background noise,
0:15.2	there's some construction going on around me today, but we're going to record anyways.
0:20.2	This week, I need to clarify a few things.
0:23.2	I promise we'll cover a super abbreviated approach to this at the end, but today, specifically,
0:29.9	we need to talk about gallbladder stuff. We need to talk terms. We need to talk diagnoses,
0:37.4	because a lot of you are getting really confused by this, as I did.
0:42.3	And I want you to sound smart, not dumb. When your patient has right upper quadrant pain, I want you to give a differential diagnosis that shows off your knowledge base to the attending.
0:55.8	I've even had attendings get these terms confused before. They don't even realize it sometimes.
1:01.2	When you say things correctly, though, you just automatically sound well read, and that is one of
1:08.4	your goals on the clerkship. So today we're going to talk about the
1:12.1	five right upper quadrant diagnoses that you need to know, specifically five billiary
1:20.1	diagnoses. Colylythiasis and biliary colic, colisestitis, colidoc, colidocytitis, colidocytitis, and gallstone pancreatitis.
1:37.0	Colylythiasis with episodes of biliary colic, colicestitis, colidoc, colidic, colidic, colidic, coliocytitis, colidocytis, coliocytitis, and gallstone pancreatitis.
1:48.2	So let's go through this.
1:50.0	First, coli lithiasis.
1:54.0	Lithiasis means stone.
1:57.0	So gallstones.
1:58.7	15% of people have coli litheisis.
2:02.6	It's incredibly, incredibly common.
2:05.1	And 1% of the people that have this will have issues with them every year.
2:11.7	You've probably heard of the phrase, fat, fertile, 40, female.
	...

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