{"id":411,"date":"2023-07-10T09:48:33","date_gmt":"2023-07-10T14:48:33","guid":{"rendered":"https:\/\/wp.uthscsa.edu\/surglearning\/?post_type=docs&#038;p=411"},"modified":"2023-07-10T14:40:04","modified_gmt":"2023-07-10T19:40:04","password":"","slug":"adult-biliary-guidelines","status":"publish","type":"docs","link":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/","title":{"rendered":"Adult Biliary Guidelines"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h2>Typical Progression<\/h2>\n<ol>\n<li>RUQ<\/li>\n<li>Labs and U\/S<\/li>\n<li>Diagnosis\n<ul>\n<li>Patient has RUQ pain<\/li>\n<li>Perform labs and ultrasound<\/li>\n<li>Diagnosis may be:<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\t\t<\/div>\n\t<\/div>\n<div class=\"vc_tta-container\" data-vc-action=\"collapse\"><div class=\"vc_general vc_tta vc_tta-accordion vc_tta-color-grey vc_tta-style-classic vc_tta-shape-rounded vc_tta-o-shape-group vc_tta-controls-align-default\"><div class=\"vc_tta-panels-container\"><div class=\"vc_tta-panels\"><div class=\"vc_tta-panel\" id=\"&#8221;1689017615557-4883b640-0bbe&#8221;\" data-vc-content=\".vc_tta-panel-body\"><div class=\"vc_tta-panel-heading\"><h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"#&#8221;1689017615557-4883b640-0bbe&#8221;\" data-vc-accordion data-vc-container=\".vc_tta-container\"><span class=\"vc_tta-title-text\">&#8221;Symptomatic<\/span><i class=\"vc_tta-controls-icon vc_tta-controls-icon-plus\"><\/i><\/a><\/h4><\/div><div class=\"vc_tta-panel-body\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><b>Check if:<\/b><\/p>\n<ol>\n<li>T. bili &gt; 1.5<\/li>\n<li>CBD &gt; 4 mm<\/li>\n<li>Alk phos &gt; 150<\/li>\n<li>AST &gt; 100<\/li>\n<li>ALT &gt; 100<\/li>\n<\/ol>\n<p><b>If yes to 1 or less,<\/b> perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up.<\/p>\n<p><b>If yes to 2 or more,<\/b> 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.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><div class=\"vc_tta-panel\" id=\"&#8221;1689017615558-e97362ab-ec50&#8243;\" data-vc-content=\".vc_tta-panel-body\"><div class=\"vc_tta-panel-heading\"><h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"#&#8221;1689017615558-e97362ab-ec50&#8243;\" data-vc-accordion data-vc-container=\".vc_tta-container\"><span class=\"vc_tta-title-text\">&#8221;Acute<\/span><i class=\"vc_tta-controls-icon vc_tta-controls-icon-plus\"><\/i><\/a><\/h4><\/div><div class=\"vc_tta-panel-body\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><b>Check if:<\/b><\/p>\n<ol>\n<li>T. bili &gt; 1.5<\/li>\n<li>CBD &gt; 4 mm<\/li>\n<li>Alk phos &gt; 150<\/li>\n<li>AST &gt; 100<\/li>\n<li>ALT &gt; 100<\/li>\n<\/ol>\n<p><b>If yes to 1 or less,<\/b> perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up.<\/p>\n<p><b>If yes to 2 or more,<\/b> 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.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><div class=\"vc_tta-panel\" id=\"&#8221;1689017760188-94927f31-471b&#8221;\" data-vc-content=\".vc_tta-panel-body\"><div class=\"vc_tta-panel-heading\"><h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"#&#8221;1689017760188-94927f31-471b&#8221;\" data-vc-accordion data-vc-container=\".vc_tta-container\"><span class=\"vc_tta-title-text\">&#8221;Choledocholithiasis&#8221;<\/span><i class=\"vc_tta-controls-icon vc_tta-controls-icon-plus\"><\/i><\/a><\/h4><\/div><div class=\"vc_tta-panel-body\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><b>Perform laparoscopic cholecystectomy with IOC.<\/b><\/p>\n<ul>\n<li><b>If the IOC is negative,<\/b> discharge the patient with appropriate follow up.<\/li>\n<li><b>If IOC is positive,<\/b> consult GI for ERCP.<\/li>\n<\/ul>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><div class=\"vc_tta-panel\" id=\"&#8221;1689017806744-5c4f9a55-5cb8&#8243;\" data-vc-content=\".vc_tta-panel-body\"><div class=\"vc_tta-panel-heading\"><h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"#&#8221;1689017806744-5c4f9a55-5cb8&#8243;\" data-vc-accordion data-vc-container=\".vc_tta-container\"><span class=\"vc_tta-title-text\">&#8221;Biliary<\/span><i class=\"vc_tta-controls-icon vc_tta-controls-icon-plus\"><\/i><\/a><\/h4><\/div><div class=\"vc_tta-panel-body\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><b>Perform serial abdominal exams.<\/b><\/p>\n<p><b>Once abdominal pain has resolved, check if:<\/b><\/p>\n<ol>\n<li>T. bili &gt; 1.5<\/li>\n<li>CBD &gt; 4 mm<\/li>\n<li>Alk phos &gt; 150<\/li>\n<li>AST &gt; 100<\/li>\n<li>ALT &gt; 100<\/li>\n<\/ol>\n<p><b>If yes to 1 or less,<\/b> perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up.<\/p>\n<p><b>If yes to 2 or more,<\/b> 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.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><div class=\"vc_tta-panel\" id=\"&#8221;1689017859762-65a733cb-f581&#8243;\" data-vc-content=\".vc_tta-panel-body\"><div class=\"vc_tta-panel-heading\"><h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"#&#8221;1689017859762-65a733cb-f581&#8243;\" data-vc-accordion data-vc-container=\".vc_tta-container\"><span class=\"vc_tta-title-text\">&#8221;Cholangitis&#8221;<\/span><i class=\"vc_tta-controls-icon vc_tta-controls-icon-plus\"><\/i><\/a><\/h4><\/div><div class=\"vc_tta-panel-body\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><b>Consult GI for ERCP<\/b><\/p>\n<p>Once ERCP performed and symptoms resolved, perform laparoscopic cholecystectomy.<\/p>\n<p>Discharge patient with appropriate follow up.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"> <a href=\"https:\/\/wp.uthscsa.edu\/surglearning\/wp-content\/uploads\/sites\/238\/2023\/07\/adult_biliary_guidelines.pdf\" title=\"\" target=\"\" rel=\"\" class=\"circle  close2x fa-lg\">\n                <i class=\"fa-lg  fas fa-file-pdf \"><\/i>\n                <span>Download the full, unabridged protocol in PDF format.<\/span><\/a> <\/div><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"Typical Progression RUQ Labs and U\/S Diagnosis Patient has RUQ pain Perform labs and ultrasound Diagnosis may be: Symptomatic cholelithiasis Check if: T. bili &gt; 1.5 CBD &gt; 4 mm Alk phos &gt; 150 AST &gt; 100 ALT &gt; 100 If yes to 1 or less, perform laparoscopic cholecystectomy. Discharge patient with appropriate follow up. [...]","protected":false},"author":35,"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"doc_category":[11],"doc_tag":[],"class_list":["post-411","docs","type-docs","status-publish","hentry","doc_category-adult"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Adult Biliary Guidelines - Trauma Protocols<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Adult Biliary Guidelines - Trauma Protocols\" \/>\n<meta property=\"og:url\" content=\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/\" \/>\n<meta property=\"og:site_name\" content=\"Trauma Protocols\" \/>\n<meta property=\"article:modified_time\" content=\"2023-07-10T19:40:04+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/\",\"url\":\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/\",\"name\":\"Adult Biliary Guidelines - Trauma Protocols\",\"isPartOf\":{\"@id\":\"https:\/\/wp.uthscsa.edu\/surglearning\/#website\"},\"datePublished\":\"2023-07-10T14:48:33+00:00\",\"dateModified\":\"2023-07-10T19:40:04+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/wp.uthscsa.edu\/surglearning\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Docs\",\"item\":\"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Adult Biliary Guidelines\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/wp.uthscsa.edu\/surglearning\/#website\",\"url\":\"https:\/\/wp.uthscsa.edu\/surglearning\/\",\"name\":\"Trauma Protocols\",\"description\":\"Trauma Protocols\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/wp.uthscsa.edu\/surglearning\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Adult Biliary Guidelines - Trauma Protocols","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/","og_locale":"en_US","og_type":"article","og_title":"Adult Biliary Guidelines - Trauma Protocols","og_url":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/","og_site_name":"Trauma Protocols","article_modified_time":"2023-07-10T19:40:04+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/","url":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/","name":"Adult Biliary Guidelines - Trauma Protocols","isPartOf":{"@id":"https:\/\/wp.uthscsa.edu\/surglearning\/#website"},"datePublished":"2023-07-10T14:48:33+00:00","dateModified":"2023-07-10T19:40:04+00:00","breadcrumb":{"@id":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/adult-biliary-guidelines\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/wp.uthscsa.edu\/surglearning\/"},{"@type":"ListItem","position":2,"name":"Docs","item":"https:\/\/wp.uthscsa.edu\/surglearning\/docs\/"},{"@type":"ListItem","position":3,"name":"Adult Biliary Guidelines"}]},{"@type":"WebSite","@id":"https:\/\/wp.uthscsa.edu\/surglearning\/#website","url":"https:\/\/wp.uthscsa.edu\/surglearning\/","name":"Trauma Protocols","description":"Trauma Protocols","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/wp.uthscsa.edu\/surglearning\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"year_month":"2026-04","word_count":428,"total_views":0,"reactions":{"happy":0,"normal":0,"sad":0},"author_info":{"name":"Kim Clark","author_nicename":"clarkks","author_url":"https:\/\/wp.uthscsa.edu\/surglearning\/author\/clarkks\/"},"doc_category_info":[{"term_name":"Adult","term_url":"https:\/\/wp.uthscsa.edu\/surglearning\/docs-category\/adult\/"}],"doc_tag_info":[],"_links":{"self":[{"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/docs\/411","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/docs"}],"about":[{"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/types\/docs"}],"author":[{"embeddable":true,"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/users\/35"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/comments?post=411"}],"version-history":[{"count":0,"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/docs\/411\/revisions"}],"wp:attachment":[{"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/media?parent=411"}],"wp:term":[{"taxonomy":"doc_category","embeddable":true,"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/doc_category?post=411"},{"taxonomy":"doc_tag","embeddable":true,"href":"https:\/\/wp.uthscsa.edu\/surglearning\/wp-json\/wp\/v2\/doc_tag?post=411"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}