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Start With Anatomy
- Use an anatomical framework for acute abdominal pain and focus first on organs in the right upper quadrant.
- Evaluate the biliary tree and liver separately to narrow the differential quickly.
Stone Location Dictates Presentation
- Stones at different levels of the biliary tree produce distinct clinical pictures.
- Cystic duct obstruction causes colicky, transient pain while lodged stones cause constant pain and systemic inflammation.
History First For Abnormal LFTs
- Always ask about prescription and over-the-counter medications, supplements, and toxins when evaluating abnormal LFTs.
- Use history plus enzyme pattern (AST/ALT vs ALP) to guide whether injury is hepatocellular or cholestatic.