Hepatobiliary topics for General Physicians
How hepatobiliary disorders is tested
Written for DHA, SMLE, DOH, QCHP, OMSB, MOH, NHRA and Kuwait MOH — the same GP licensing mix, not a hepatobiliary disorders specialist paper.
HPB GP items are Tokyo cholecystitis, Charcot/Reynolds cholangitis, ERCP vs cholecystectomy timing and who is too septic for the endoscopy suite.
Acute cholecystitis: diagnose, resuscitate, early laparoscopic cholecystectomy when fit. Choledocholithiasis needs LFTs plus ultrasound, then MRCP or ERCP by probability.
Ascending cholangitis is fluids, antibiotics and source control (ERCP). HCC screening in cirrhosis appears; transplant listing criteria do not.
Charcot vs Reynolds — why does it matter?
Reynolds adds shock and confusion: this patient needs organ support and urgent biliary decompression, not an outpatient ERCP slot next week.
When is MRCP better than jumping to ERCP?
Intermediate probability stones where you want to avoid unnecessary sphincterotomy. High probability with cholangitis goes to therapeutic ERCP.
Acalculous cholecystitis — typical stem?
ICU patient, fever, thick gallbladder, no stones. Percutaneous cholecystostomy often beats a difficult cholecystectomy.
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