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Adult Biliary Guidelines

1 min read

Typical Progression

  1. RUQ
  2. Labs and U/S
  3. Diagnosis
    • Patient has RUQ pain
    • Perform labs and ultrasound
    • Diagnosis may be:

Symptomatic cholelithiasis

Check if:

  1. T. bili > 1.5
  2. CBD > 4 mm
  3. Alk phos > 150
  4. AST > 100
  5. ALT > 100

If yes to 1 or less, perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up.

If yes to 2 or more, perform laparoscopic cholecystectomy with IOC. If the IOC is negative, discharge the patient with appropriate follow up. If IOC is positive, consult GI for ERCP.

Acute cholecystitis

Check if:

  1. T. bili > 1.5
  2. CBD > 4 mm
  3. Alk phos > 150
  4. AST > 100
  5. ALT > 100

If yes to 1 or less, perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up.

If yes to 2 or more, perform laparoscopic cholecystectomy with IOC. If the IOC is negative, discharge the patient with appropriate follow up. If IOC is positive, consult GI for ERCP.

Choledocholithiasis

Perform laparoscopic cholecystectomy with IOC.

  • If the IOC is negative, discharge the patient with appropriate follow up.
  • If IOC is positive, consult GI for ERCP.

Biliary pancreatitis

Perform serial abdominal exams.

Once abdominal pain has resolved, check if:

  1. T. bili > 1.5
  2. CBD > 4 mm
  3. Alk phos > 150
  4. AST > 100
  5. ALT > 100

If yes to 1 or less, perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up.

If yes to 2 or more, perform laparoscopic cholecystectomy with IOC. If the IOC is negative, discharge the patient with appropriate follow up. If IOC is positive, consult GI for ERCP.

Cholangitis

Consult GI for ERCP

Once ERCP performed and symptoms resolved, perform laparoscopic cholecystectomy.

Discharge patient with appropriate follow up.

Download the full, unabridged protocol in PDF format.