July 2014 Case of the Month- Courtesy of Ben Cleary

A 47yo patient presented to the ED with c/o jaundice.   He denied abdominal pain or other associated symptoms.  He was afebrile.  His labs were significant for mildly elevated transaminases and elevated bilirubin, but a normal lipase, consistent with an obstructive process.

A bedside ultrasound revealed the following:

The images demonstrate choledocholithiasis – the presence of gallstones in the bile duct.   Stones in the bile duct are often asymptomatic but can present with abdominal pain, obstructive jaundice, pancreatitis or an infection (ascending cholangitis).  The sensitivity of bedside ultrasound to detect stones in the bile duct is variable, ranging from 13-55%.   EUS (endoscopic ultrasonography) has a much higher sensitivity.   Once identified, ERCP is the treatment of choice.  The patient was admitted and evaluated by GI.  He also had a CT which demonstrated a dilated CBD (see below).  He is currently scheduled to undergo ERCP with sphincterotomy.

CT CBD Widening

 

 

 

An official welcome to our new US fellows…Becca, Ellen and Amit!

Our new fellows have arrived!

BeccaBurton Becca just completed her PEM Fellowship at NYU/Bellevue!  She attended medical school at Cornell University and completed residency at UCSF.

EK website Ellen joins us from NJ where she attended medical school at Rowan University School of Osteopathic Medicine (formerly UMDNJ-School of Osteopathic Medicine) and completed her combined EM/IM residency at Kennedy University Hospital/Rowan University SOM.

IMG_3735 Amit attended medical school at the University of Maryland School of Medicine and joins us from Brooklyn where he completed his EM residency at Maimonides Medical Center, more affectionately known as “Maimo”!