The EM Educator Series: Why is my patient with gallbladder pathology so sick?

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Cases:

#1: A 43-year-old female presents with right upper quadrant pain and nausea. She ate a large meal approximately 2 hours ago. This is the third time this has happened, but each time before the pain resolved spontaneously.

#2: A 74-year-old male presents with jaundice, fever, and right upper quadrant pain for 2 days. He appears toxic.

Considerations:

• What is the spectrum of gallbladder disease?
• What sources do you need to consider in sepsis? What about the abdomen?
• How does cholangitis present? Can it vary? Why do we miss it?
• What is the ED evaluation of cholangitis?
• How is cholangitis managed?

Suggested resources:

• Articles:
  • CORE EM – Cholangitis
  • emDOCs.net – So you think it is sepsis: considerations beyond lung and urine in the sick patient without a source
  • emDOCs.net – Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain
  • Ely, Rachel, Brit Long, and Alex Koyfman. “The Emergency Medicine− Focused Review of Cholangitis.” The Journal of emergency medicine 54.1 (2018): 64-72.