Cholelithiasis 胆石による病気 （USMLE対策）

Cholelithiasis

Biliary colic --- "spasm" of cystic duct, epigastric pain, dull and constant pain(not really "colic"), no predisposing factors, usually lasts < 3hrs.

Cholecystitis --- If bilialy colic lasts more than 3 hrs and location shifts from epigastric to RUQ, it is cholecystitis (inflammation).  It has tenderness and radiates to back, so need to r/o pancreatitis.

Choledocholithiasis --- The obstruction at CBD but no inflammation. There could be jaundice but no pain.

Cholangitis --- USG to rule out (high specificity, low sensitivity), Blood Cx, IV fluid, Gram negative drugs (GN drugs cover anaerobs in general however cipro/FQ/Aztreonam does not. If you use cipro/FQ/Aztreonam as GN coverage then you need to add metronidzole for anaerobs coverage). ERCP is the most accurate diagnostic test.

臨床的な違いをまとめた図。

Cholangitisには、Anaerobes（嫌気性菌）の関与が少ない（～10％）ことを銘記。

Pancreatitis--- Amylase, lipase, LFTs, CT to comfirm Dx, NPO, IV Fluid, pain control, If febrile, do blood cx and ABx (ABPC+GM+Metronidazole) or penem, Contrast CT is largely replacing Ranson's criteria for surgical intervention to debride necrotizing pancreatitis.

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