Step II choledocholithiasis workup

Started by Anicetus
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
Anicetus

Anicetus

Full Member
10+ Year Member
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!
 
Sort by date Sort by votes
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.
 
Upvote 0 Downvote
You must log in or register to reply here.