Magnetic resonance cholangiopancreatography

The levophed and vasopressin requirements didn't improve.

So they rush him to MRI for an MRCP, a magnetic resonance cholangiopancreography.

It's an MRI specifically tuned using highly T2 weighted sequences to look exclusively at stationary fluid like bile.

And it revealed that the problem wasn't fully solved.

The MRCP showed that the main common bile duct was draining perfectly through the new stent, but the gallbladder itself was still completely walled off.

The cystic duct, the tiny tube connecting the gallbladder to the main drain, was obstructed by swelling and smaller stones.

The gallbladder was functioning as a massive isolated pocket of trapped pus, an empyema.

We use CT a lot to follow the progression of disease, but MRI is what gives you that key component of it.

So MRI with MRCP gives the best picture of the patient's ductal anatomy.

In adults, alcohol and gallstones are the usual causes of pancreatitis.

But what causes pancreatitis in children?

Yeah, that's, that's great of the team, um, to get that CT scan.

And, and quite frankly, if you're really worried about the biliary system, something that's more, uh, sensitive than a CT scan would be an MRCP.

B- I think it's also really important to see, like, what does his liver chemistry test look like, you know, in eight a-- Assuming that he's been admitted to the hospital, what does it look like the next day, um, to see if it's, like, downtrending or not or if it's dynamic, because that can help influence, uh, the DDX.

But I think for this individual, we've ruled out spontaneous bacterial peritonitis.