Where’s the Blockage?
Complication Cascade
What’s the Next Step?
100
A 42-year-old woman presents with episodic RUQ pain after eating fatty meals. Episodes last 30–60 minutes and resolve spontaneously. She is afebrile. Labs are normal. Ultrasound shows gallstones without wall thickening or biliary dilation (see below)
What is symptomatic cholelithiasis (biliary colic)?
100
A patient with untreated acute cholecystitis develops worsening RUQ pain and high fever. Imaging shows pus filling the gallbladder lumen.
What is gallbladder empyema (suppurative cholecystitis)?
100
A 45-year-old woman presents with persistent RUQ pain, fever, leukocytosis, and ultrasound findings consistent with acute cholecystitis. She is hemodynamically stable.
What is early laparoscopic cholecystectomy with IV antibiotics?
200
A 50-year-old woman presents with persistent RUQ pain, fever, nausea, and vomiting. Exam reveals a positive Murphy sign. Ultrasound shows gallstones, gallbladder wall thickening, and pericholecystic fluid.
What is acute calculous cholecystitis?
200
A patient with acute cholecystitis suddenly develops diffuse abdominal pain with rebound tenderness. CT demonstrates the following.
What is gallbladder perforation?
200
A patient presents with jaundice and RUQ pain. Labs show elevated bilirubin and ALP. MRCP reveals a stone obstructing the common bile duct.
What is ERCP with stone extraction?
300
A 63-year-old man presents with jaundice and RUQ pain. Labs show elevated bilirubin and ALP. Ultrasound demonstrates dilation of the common bile duct.
What is choledocholithiasis?
300
A 68-year-old diabetic man with RUQ pain and fever has CT imaging showing the following:
What is emphysematous cholecystitis?
300
A patient presents with fever, jaundice, RUQ pain, hypotension, and confusion.
What is urgent biliary decompression with ERCP plus IV broad-spectrum antibiotics?
400
A patient presents with fever, jaundice, RUQ pain, hypotension, and confusion. Labs show elevated bilirubin and leukocytosis.
What is acute ascending cholangitis?
400
A patient with gallstones develops severe epigastric pain radiating to the back with nausea and vomiting. Lipase is markedly elevated.
What is gallstone pancreatitis?
400
An 82-year-old ICU patient with severe acute cholecystitis is septic and considered too unstable for surgery.
What is percutaneous cholecystostomy?
500
A 47-year-old woman presents with jaundice and pruritus but minimal abdominal pain. Labs show markedly elevated ALP and bilirubin. MRCP demonstrates obstruction of the distal common bile duct by a stone. Several hours later, she develops fever and hypotension.
(a) gallbladder, (e) cystic duct, (b) common bile duct, (c) pancreatic duct, (d) duodenum
What is choledocholithiasis progressing to acute cholangitis?
500
An elderly patient with chronic gallstone disease develops abdominal distention, vomiting, and inability to pass stool. CT shows pneumobilia and small bowel obstruction.
What is gallstone ileus due to a cholecystoenteric fistula?
500
A patient with gallstone pancreatitis develops fever, jaundice, hypotension, and worsening cholestatic labs.
What is urgent therapeutic ERCP for biliary decompression?