Bedside
What is the expected result of Murphy’s Sign in Cholecystitis vs. Cholangitis?
Positive in cholecystitis, often negative in Cholangitis
How do you interpret a High WBC in a patient with RUQ pain?
Indicates infection, very high in jaundiced patient more common for cholangitis
What are the "Big Three" findings on Ultrasound for Cholecystitis?
1. Gallstones, 2. Gallbladder wall thickening (>3mm), 3. Pericholecystic fluid.
If a Urinalysis shows the presence of Bilirubin, which condition does this point toward?
Indicative of cholangitis
What do elevated ALP and GGT tell you about the location of the pathology?
Indicate cholestasis usually pointing to cholangitis
If a HIDA Scan shows "non-filling" of the gallbladder, what is the diagnosis?
Confirms acute cholesystitis
How do observations (e.g. vitals) differ between simple Cholecystitis and severe Cholangitis?
Cholecystitis usually = pain and fever, cholangitis = tachycardia and hypotension
What is the significance of a Positive Blood Culture in a biliary case?
Confirms bacteremia which is caused by cholangitis
When would you order an MRCP instead of going straight to an ERCP?