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.