Pre-op visit

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Maybe. LFTs' in the 1000's is not cholecystitis. That is more like a CBD problem. So if she is symptomatic, maybe an ERCP maybe the way to go.... although sometimes you can see a dilated CBD on USD... if the obstruction is big enough.

Slightly off topic but actually US is great for diagnosing a CBD stone/obstruction. Generally the go to test (at least here), had exactly one patient this year get an MRCP and we didn't order it.


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I didn't see fractionated and total bilirubin mentioned with the other lfts. Would be good to know those. That plus ultrasound is pretty good at letting you know an ercp needed.
 
I didn't see fractionated and total bilirubin mentioned with the other lfts. Would be good to know those. That plus ultrasound is pretty good at letting you know an ercp needed.

Exactly how we did it. MRCP is generally a waste of time. Good story + elevated bili + big CBD on U/S went for ERCP for both diagnosis and treatment. The one MRCP I mentioned above was in someone too sick for the ERCP, we wanted to just put in the PTC tube but IR wouldn't do it without more proof that was the problem.
 
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Oh and amylase/lipase. Mrcp can help with gallstone panc issues too where us won't show panc duct well with inflammation. A triple phase ct will also tell you about a crappy pancreas though too, not so much for gallstones though
 
ischaemic hepatitis?
seems more likely to me than des induced (0.02% is metabolised) or propofol induced
 
I haven't looked at this thread in a while but it seems like you guys are missing something.
This exact thing happened the last time she had a GA.
 
Why would this happen twice?
i don't want to come across as criticising - i wasn't there, and I dont know anything about your case or the patient.

the most common cause of deranged lfts after general anaesthesia is ischaemic hepatitis, I imagine this is precipitated by a period of hypoperfusion in a patient susceptible to it...
 
i don't want to come across as criticising - i wasn't there, and I dont know anything about your case or the patient.

the most common cause of deranged lfts after general anaesthesia is ischaemic hepatitis, I imagine this is precipitated by a period of hypoperfusion in a patient susceptible to it...
You may be right but in this case you are wrong. Just because something is most common doesn't mean it's the cause.
 
You may be right but in this case you are wrong. Just because something is most common doesn't mean it's the cause.
no worries noyac, apologies if you feel I was being critical - that wasn't my intention.
 
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