• Middle-aged woman with recent lap chole presenting with five days of fever, jaundice, and RUQ tenderness with labs showing a leukocytosis with cholestatic pattern (Alkaline phosphatase >> AST), most concerning for acute cholangitis that needs to be rapidly evaluated with an ERCP (associated with significant morbidity/mortality)
• Key idea: Acute cholangitis –> Fever, jaundice, RUQ pain (Charcot’s triad) + hypotension, altered mental status (Reynold’s pentad)
• Key idea: Even though patient has had cholecystectomy, they can still develop acute cholangitis due to a residual stone in the common bile duct or a retained gallstone in the cystic duct stump

https://step-prep.org/tutoring/

Patients who complain of persistent RUQ pain after cholecystectomy should be evaluated for post-cholecystectomy syndrome

Evaluated via abdominal imaging (e.g. ultrasound) followed by direct visualization (e.g. ERCP, MRCP) to find and remove the stone.

etiologies include:

• biliary (e.g. retained cystic duct stone, damage to the duct)
• extra-biliary (e.g. pancreatitis) causes.