Cholecystitis, choledocholithiasis, cholangitis, Mirizzi, gallstone ileus.
| Condition | Presentation | Diagnosis | Management |
|---|---|---|---|
| Biliary colic | RUQ pain radiating to scapula, fatty meal trigger, resolves hours | RUQ US → stones | Analgesia + elective lap cholecystectomy |
| Acute cholecystitis | Constant RUQ pain + fever + leukocytosis + Murphy | RUQ US (wall thickening, pericholecystic fluid); HIDA if equivocal | NPO, IV fluids, IV abx (piperacillin-tazobactam), cholecystectomy <72 hr |
| Choledocholithiasis | RUQ/epigastric + jaundice; cholestatic LFTs (↑direct bili, ↑ALP, ↑GGT) | US: dilated CBD; MRCP | ERCP stone extraction → cholecystectomy |
| Acute cholangitis | Charcot triad (RUQ pain + jaundice + fever); Reynolds pentad adds AMS + hypotension | Leukocytosis + cholestasis; ERCP diagnostic + therapeutic | IV fluids + abx → urgent ERCP biliary decompression |
| Mirizzi syndrome | Stone in cystic duct compresses common hepatic duct → obstructive jaundice | MRCP shows extrinsic compression | ERCP or surgery to relieve obstruction |
| Gallstone ileus | Large stone erodes through fistula → SBO; elderly women | Pneumobilia + SBO on imaging | Enterolithotomy + fistula repair |