Severely afflicted patients may also display an

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biliary system termed acute cholangitis. Severely afflicted patients may also display an altered mental status and hypotension ( pentad of Reynolds ). Fever should be viewed as a signal that an otherwise localized disease process has progressed to a systemic illness. Laboratory Tests Simple biliary colic, in the absence of gallbladder wall pathology or common bile duct obstruction, does not produce abnormal laboratory test values. On the other hand, obstructive choledocholithiasis is commonly associated with an element of both liver dysfunction and acute cellular injury with resultant elevations in liver function tests. In addition to hyperbilirubinemia, the magnitude of which directly correlates with the severity and duration of the biliary system blockade, an increased serum alkaline phosphatase level is virtually pathognomonic of bile duct obstruction. Serum transaminase (aspartate and alanine) levels can also be mildly elevated in biliary system disease, either because of direct injury of the liver adjacent to an inflamed gallbladder or from the effect of biliary sepsis on hepatocellular membrane integrity. Leukocytosis with a predominance of neutrophils is often present with acute cholecystitis or cholangitis, but is a nonspecific finding that does not distinguish these conditions from other infectious or inflammatory processes within the abdomen. Radiographic Studies ABDOMINAL RADIOGRAPHS Although frequently obtained during the initial evaluation of abdominal pain, plain radiographs of the abdomen are seldom of significant diagnostic value. Only about 15% of gallstones contain enough calcium to render them radiopaque and thus visible on plain films of the abdomen. The most important value of plain abdominal films is the exclusion of other potential diagnoses, such as a perforated ulcer with free intraabdominal air or an intestinal obstruction with dilated loops of bowel and multiple air– fluid levels. ULTRASONOGRAPHY Surface ultrasound of the abdomen is an extremely useful and accurate method for identifying gallstones and pathological changes in the gallbladder consistent with acute cholecystitis. Abdominal ultrasound should be part of the routine evaluation of patients suspected of having gallstone disease, given the high specificity (98%) and sensitivity (95%) of this test for the diagnosis of cholelithiasis. In addition to confirming the presence of gallstones within the gallbladder, ultrasound can also detail various signs of acute cholecystitis (thickening of the gallbladder wall, pericholecystic fluid) as well as gallbladder neoplasms. COMPUTED TOMOGRAPHY (CT) Although abdominal CT scanning is probably the most informative single 5
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radiographic tool for examining intraabdominal pathology, its overall value for the diagnosis of biliary tract disease pales in comparison to ultrasonography. This disadvantage is largely because gallstones and bile appear nearly isodense on CT; that is, it is difficult to distinguish gallstones from bile, unless the stones are heavily calcified. Therefore, CT documents the
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  • Winter '18
  • Jane doe
  • bile duct, Hepatology, Gallstone

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