Incidence
Age
Sex
Geography
Aetiology
Presentation	- may be asymptomatic - triad of abdo pain, jaundice, fever - severe pain in epigastrium and R hypochondrium ± vomiting; lasts for a few hours and then clears up - patient is well between attacks - jaundice is accompanied by dark urine and pale stools - high fevers or rigors indicate cholangitis - liver may be enlarged if the attack lasts more than a few hours Differential diagnosis - all causes of jaundice - causes of upper abdominal pain
Investigations	FBC - leucocytosis Blood cultures - may show growth of an intestinal organism - E. coli or S. faecalis LFTs - elevated conjugated bilirubin and ALP - relatively normal AST/ALT Clotting - PT may be elevated due to poor Vitamin K absorption USS - dilated CBD ± visible stone - endoscopic USS is a more accurate way fo detecting a stone - stones in gallbladder suggest gallstone aetiology AXR - 10% of gallstones are visible on a plain film ERCP - confirm diagnosis - remove stones MRCP
Macro
Micro
Staging
Serum markers
Management	- allow acute episode to settle; may require pain releif or antibiotics
Prognosis
Complications

Hepatobiliary medicine

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