choledocholithiasis workup

[Anicetus]

Hey all,

Came across a problem in pretest family medicine regarding the perfect picture of choledocholithiasis (elevated liver function tests, alk phos, WBC, plus Charcot triad) and the next step was to jump to ERCP instead of start with ultrasound.

Wouldn't you need to visualize the dilated ducts with a RUQ ultrasound before just making a jump to ERCP? (This concept mentioned in Online Meded)

Thanks!

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[Code Blah]

Yeah you go straight to ERCP because with Charcot's triad, it's not just choledocholithiasis anymore, it's ascending cholangitis. These patients are SICK SICK SICK. They need immediate intervention. You do ERCP to diagnose and treat at the same time. RUQ US would not be useful because the stone is in the bile duct which can be covered up by intestines and bowel gas, so the detection of choledochilithiasis by US is actually very low. I think you're getting it confused with cholelithiasis, in which RUQ US is test of choice.