Gastroenterology

Answer 2 Ultrasonography of the right upper quadrant. When there is a strong suspicion of gallstone-induced pancreatitis, ultrasound is the imaging modality of choice; it is inexpensive, can be obtained quickly, and is extremely sensitive in detecting gallstones and a dilated common bile duct. However, when the diagnosis of pancreatitis is in doubt or the suspicion of gallstone-induced pancreatitis is low, a contrast-enhanced computed tomographic (CT) scan is the best study to evaluate the abdomen. Endoscopic retrograde cholangiopancreatography may be required to decompress obstructed biliary and pancreatic ducts, but it is a poor diagnostic test in this patient’s situation. In patients with acute pancreatitis, plain abdominal radiographs frequently show no abnormalities or may reveal nonspecific findings such as an ileus. A percutaneous cholangiogram is not indicated for this patient, because it is invasive and is rarely performed for diagnostic purposes alone. Click here to return to the questions

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