Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 30: A 56-Year-Old Female Presents With Recurrent Ruq Pain, Impaired Lfts, Elevated Alkp, And Transaminases. She Had A Prior Ercp And Possible Biliary Papillotomy For Similar Complaints But She Does Not Recall The Diagnosis. What Should I Do? (continued)


The common complaint of right upper quadrant (RUQ) pain and impaired liver function tests (LFTs) could suggest biliary obstruction secondary to ductal stones and possible cholangitis if there is fever or chills and other constitutional symptoms. Less commonly, it can be related to attacks of pain associated with sphincter of Oddi dysfunction (SOD). However, late complications of postpapillotomy stenosis remain a possibility in the differential diagnosis. The clinical diagnosis of SOD is based on the presence of biliary-type pain and evidence of bile duct obstruction, ie, dilated biliary…