Cholelithiasis: The Daily PANCE Blueprint

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Cholelithiasis: The Daily PANCE Blueprint

A 42-year-old female with a history of obesity and diabetes presents to the ER with sharp pain in the right upper abdomen that occurs after eating. She tells you these episodes happen frequently. She is normotensive, afebrile, and on room air. Liver function tests reveal mildly elevated AST, ALT, ALP, and GGT. Abdominal ultrasound reveals highly reflective echogenic foci within the gallbladder lumen. There is no gallbladder wall thickening. Which of the following is the preferred treatment for this patient?

A. Elective cholecystectomy
B. Intravenous antibiotics and fluids
C. Endoscopic retrograde cholangiopancreatography
D. Fluid resuscitation and pain medications only
E. None of the above

Answer and topic summary

The answer is A. Elective cholecystectomy

The patient has cholelithiasis, which refers to stones in the gallbladder (i.e., gallstones). Etiologies include obesity/diabetes, cirrhosis, cystic fibrosis, Crohn’s disease, oral contraceptives, hemolysis, etc. Most cases are asymptomatic. However, biliary colic is the classic symptom you may see; it is due to temporary obstruction of the cystic duct by a gallstone. Pain happens when the gallbladder tries to contract against the obstruction. Diagnosis is ideally made with RUQ ultrasound. No treatment is indicated unless the patient is symptomatic. Elective cholecystectomy is the preferred definitive treatment.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Biliary Disorders ⇒ Cholelithiasis

Also covered as part of the Internal Medicine EOR, Family Medicine EOR, and General Surgery EOR topic list

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