Original chalk talk by Brandon Fainstad, MD.
Graphics, updates and edits by Yilin Zhang, MD.
- Review biliary anatomy
- Recognize complications of gallstone disease
- Recognize the utility of diagnostic imaging and therapeutic options for complications of gallstone disease
This talk can be replicated on the board as a chalk talk or the website itself can be used as the teaching platform. Click on each figure for teaching instructions and additional information. Any new text that appears in each figure is displayed in green.
Board set-up and review of biliary anatomy:
TAKE HOME POINTS:
- US is widely used for the diagnosis of cholelithiasis or cholecystitis. HIDA scans have the best sensitivity and specificity but are not readily available. The sensitivity of CT scans are unclear, but can miss stones that are isodense with bile.
- While RUQ US can show evidence of biliary ductal dilation suggestive of choledocholithiasis or cholangitis, ERCP or MRCP is superior at delineating biliary anatomy.
- Patients with cholecystitis and cholangitis require drainage of the gallbladder or biliary tree with cholecystectomy or ERCP, respectively. Patients who cannot receive these procedures can undergo percutaneous drainage.
- Bellow, CF, Berger, DH & Crass, RA. Management of Gallstones. 2005. American Academy of Family Physicians.
- Zakko, SF & Afdhal NH. Acute cholecystitis: Pathogenesis, clinical features, and diagnosis. In Grover, S (ed). UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on December, 02, 2017.)
- Kiewiet, JJ, et al. A Systematic Review and Meta-Analysis of Diagnostic Performance of Imaging in Acute Cholecystitis. Radiology. 2012, 264(3):708-720.
- Arain, MA & Freeman, ML. Choledocholithiasis: Clinical manifestations, diagnosis and management. In Grover, S (ed). UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on December, 02, 2017.)
- Afdhal, NM. Acute cholangitis. In Grover, S (ed). UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on December, 02, 2017.)
- ERCP cholangiogram – http://www.uptodate.com/contents/images/GAST/70088/Obstructing_CBD_stone_ERCP.jpg?title=Obstructing+CBD+stone+ERCP
- ERCP stone removal and sphinceroteromy – http://www.uptodate.com/contents/images/GAST/67640/Endosc_stone_extraction.jpg?title=Endosc+stone+extraction
- ERCP cholangitis pre/post – http://www.uptodate.com/contents/images/GAST/62967/Acute_cholangitis_ERCP.jpg?title=Acute+cholangitis+ERCP