RUQ pain + normal labs
→ Biliary colic

RUQ pain + fever + WBC ↑
→ Acute cholecystitis

RUQ pain + jaundice + ALP/Bili ↑
→ Choledocholithiasis

RUQ pain + fever + jaundice
→ Acute cholangitis

RUQ pain + fever + jaundice + hypotension + AMS
→ Severe cholangitis (Reynolds pentad)

Epigastric pain radiating to back + lipase ↑
→ Acute pancreatitis

Lipase ↑ + ALT >150
→ Gallstone pancreatitis

Painless jaundice + weight loss
→ Cholangiocarcinoma or pancreatic cancer until proven otherwise

LFT Pattern Cheat Sheet

AST/ALT >> ALP
→ Hepatocellular injury

• Viral hepatitis

• Ischemic hepatitis

• Drug-induced liver injury

ALP/Bilirubin >> AST/ALT
→ Obstructive/cholestatic disease

• Choledocholithiasis

• Cholangitis

• PSC

• PBC

• Cholangiocarcinoma

AST:ALT >2
→ Alcohol-associated hepatitis

ALT >150 in acute pancreatitis
→ Strongly suggests gallstone pancreatitis

Imaging of Choice

Biliary colic/cholecystitis
→ RUQ US

Choledocholithiasis
→ MRCP or EUS

Cholangitis
→ ERCP (diagnostic + therapeutic)

Gallstone pancreatitis
→ RUQ US first

PSC
→ MRCP

Cancer/stricture
→ CT + MRCP ± ERCP biopsy