A Man With Recurrent RUQ Pain & N&V For 3 Months + Yellow Skin There Is Abnormal Liver Enzymes And Bilirubin…

Explanation

Core Concept: Recurrent RUQ pain with nausea/vomiting, jaundice, abnormal liver enzymes, and elevated bilirubin suggests biliary obstruction, most commonly from choledocholithiasis (common bile duct stones). MRCP (Magnetic Resonance Cholangiopancreatography) is the most appropriate imaging modality as it provides excellent visualization of the biliary and pancreatic ductal systems without radiation or contrast, and can identify the level and cause of obstruction.

Clinical Presentation:

• Recurrent RUQ pain (biliary colic), nausea, vomiting.
• Obstructive jaundice: Yellow skin/sclera, dark urine, pale stools, pruritus.
• RUQ tenderness on examination.
• Complications: Acute cholangitis (Charcot's triad), pancreatitis, liver abscess.

Diagnosis:

• First-line tool: Abdominal ultrasound (initial screening for gallstones and CBD dilation) + Liver function tests.
• Gold standard: MRCP for non-invasive detailed biliary imaging. ERCP if therapeutic intervention is needed (stone extraction, stenting).

Management:

• Acute: If cholangitis suspected: IV antibiotics, fluid resuscitation, urgent ERCP for drainage.
• Long-term/Definitive: ERCP with sphincterotomy and stone extraction for CBD stones. Elective cholecystectomy to prevent recurrence. Follow-up LFTs.