Biliary Triage: Is the Stone Stuck, Is the Bile Infected
Biliary disease is graded by two questions only — is the stone stuck, and is the bile infected. Build a patient from real findings and watch the diagnosis and its urgency shift from an elective clinic visit to a septic emergency. Then switch to the ward and sort what you see after surgery and after ERCP into what you manage yourself and what makes you pick up the phone.
Pain pattern
Fever and white cell count
Bilirubin and alkaline phosphatase
Blood pressure and mental status
Whether the patient has symptoms depends on whether a stone moves
Stones sitting in the gallbladder are often silent. A stone that lodges in the cystic duct gives colic; one that stays gives cholecystitis; one that lodges in the common bile duct obstructs the liver and, because the pancreatic duct joins at the ampulla, potentially the pancreas as well.