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    Background: Essential Update: Early Endoscopic Ultrasonography A Good First Test For Suspected CBD Stones

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    Dann Francis Sarnillo
    Early endoscopic ultrasonography (EUS) is a good first test for evaluating patients suspected of having common bile duct (CBD) stones, according to a prospective study. The study of 179 patients found that EUS helped distinguish those who might benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) from those who did not need it. EUS detected CBD stones in 48% of patients overall and correctly identified stones in 86 patients that were later confirmed by ERCP. EUS detected stones in 20% of low risk patients, 51% of moderate risk patients, and 67% of high risk patients.

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    Background: Essential Update: Early Endoscopic Ultrasonography A Good First Test For Suspected CBD Stones

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    Dann Francis Sarnillo
    29 views2 pages
    Early endoscopic ultrasonography (EUS) is a good first test for evaluating patients suspected of having common bile duct (CBD) stones, according to a prospective study. The study of 179 patients found that EUS helped distinguish those who might benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) from those who did not need it. EUS detected CBD stones in 48% of patients overall and correctly identified stones in 86 patients that were later confirmed by ERCP. EUS detected stones in 20% of low risk patients, 51% of moderate risk patients, and 67% of high risk patients.

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    Background.

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    Early endoscopic ultrasonography (EUS) is a good first test for evaluating patients suspected of having common bile duct (CBD) stones, according to a prospective study. The study of 179 patients found that EUS helped distinguish those who might benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) from those who did not need it. EUS detected CBD stones in 48% of patients overall and correctly identified stones in 86 patients that were later confirmed by ERCP. EUS detected stones in 20% of low risk patients, 51% of moderate risk patients, and 67% of high risk patients.

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    29 views2 pages

    Background: Essential Update: Early Endoscopic Ultrasonography A Good First Test For Suspected CBD Stones

    Uploaded by

    Dann Francis Sarnillo
    Early endoscopic ultrasonography (EUS) is a good first test for evaluating patients suspected of having common bile duct (CBD) stones, according to a prospective study. The study of 179 patients found that EUS helped distinguish those who might benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) from those who did not need it. EUS detected CBD stones in 48% of patients overall and correctly identified stones in 86 patients that were later confirmed by ERCP. EUS detected stones in 20% of low risk patients, 51% of moderate risk patients, and 67% of high risk patients.

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    Background

    Cholelithiasis involves the presence of gallstones, which are concretions that form in the biliary tract, usually in the gallbladder. Choledocholithiasis refers to the presence of 1 or more gallstones in the common bile duct (CBD). Treatment of gallstones depends on the stage of disease.

    Essential update: Early endoscopic ultrasonography a good first test for suspected CBD stones
    In a prospective study of 179 consecutive patients with suspected choledocholithiasis, Anderloni et al found that early endoscopic ultrasonography (EUS) helped distinguish between patients who might benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and those who did not need ERCP.[1, 2] Of the 179 patients, 48 were classified as being at low risk for choledocholithiasis, 65 as being at moderate risk, and 66 as being at high risk.[1, 2] CBD stones were detected by means of EUS in 86 patients (48%) overall and were confirmed by means of ERCP in 79. EUS detected choledocholithiasis in 20% of the low-risk group, 51% of the moderate-risk group and 67% of the high-probability group.

    Signs and symptoms


    Gallstone disease may be thought of as having the following 4 stages: 1. 2. 3. 4. Lithogenic state, in which conditions favor gallstone formation Asymptomatic gallstones Symptomatic gallstones, characterized by episodes of biliary colic Complicated cholelithiasis

    Symptoms and complications result from effects occurring within the gallbladder or from stones that escape the gallbladder to lodge in the CBD. Characteristics of biliary colic include the following:

    Sporadic and unpredictable episodes Pain that is localized to the epigastrium or right upper quadrant, sometimes radiating to the right scapular tip Pain that begins postprandially, is often described as intense and dull, typically lasts 1-5 hours, increases steadily over 10-20 minutes, and then gradually wanes Pain that is constant; not relieved by emesis, antacids, defecation, flatus, or positional changes; and sometimes accompanied by diaphoresis, nausea, and vomiting Nonspecific symptoms (eg, indigestion, dyspepsia, belching, or bloating)

    Patients with the lithogenic state or asymptomatic gallstones have no abnormal findings on physical examination. Distinguishing uncomplicated biliary colic from acute cholecystitis or other complications is important. Key findings that may be noted include the following:

    Uncomplicated biliary colic Pain that is poorly localized and visceral; an essentially benign abdominal examination without rebound or guarding; absence of fever Acute cholecystitis Well-localized pain in the right upper quadrant, usually with rebound and guarding; positive Murphy sign (nonspecific); frequent presence of fever; absence of peritoneal signs; frequent presence of tachycardia and diaphoresis; in severe cases, absent or hypoactive bowel sounds

    The presence of fever, persistent tachycardia, hypotension, or jaundice necessitates a search for complications, whi

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