Date:
Patient:
Reason for Visit:
Initial evaluation for suspected Sphincter of Oddi dysfunction (SOD)
Follow-up for diagnosed SOD
Assessment of treatment response or management strategies
Evaluation of recurrent symptoms
History:
Presenting Illness: (For initial evaluation)
Onset, duration, and character of abdominal pain (typically right upper quadrant, postprandial – after meals)
Frequency and severity of pain episodes
Associated symptoms (nausea, vomiting, bloating)
Response to pain medications or dietary changes
Past medical history of relevant conditions (gallbladder disease, pancreatitis)
Past surgeries (cholecystectomy – gallbladder removal)
Past Medical History (PMH):
Comorbid conditions (e.g., peptic ulcer disease, irritable bowel syndrome) that may contribute to symptoms.
Medications (including over-the-counter) currently being taken.
Social History:
Alcohol use (may be a risk factor)
Smoking history
Physical Exam:
Abdominal: Evaluate for tenderness in the right upper quadrant, Murphy’s sign (pain upon palpation during deep inspiration).
Jaundice: Look for signs of yellowing of the skin or sclerae (suggestive of biliary obstruction).
Diagnostic Tests (may be ordered depending on clinical suspicion):
Imaging Studies:
Abdominal ultrasound – may show dilated common bile duct (suggestive of obstruction).
Hepatobiliary scintigraphy (HIDA scan) – assesses gallbladder function and emptying.
Magnetic resonance cholangiopancreatography (MRCP) – visualizes the bile ducts and pancreatic duct for abnormalities.
Endoscopic retrograde cholangiopancreatography (ERCP) (used for diagnosis and potential treatment):
Involves injecting contrast dye into the bile and pancreatic ducts through an endoscope to identify narrowing or other abnormalities.
During ERCP, sphincter of Oddi manometry can be performed to measure pressure within the sphincter.
Assessment:
Clinical suspicion of SOD: Based on history, physical exam findings, and exclusion of other potential causes of the symptoms.
SOD diagnosis is challenging due to overlapping symptoms with other conditions.
Confirmation of SOD: Can be difficult, often relies on response to ERCP with sphincter manometry demonstrating elevated resting or post-stimulation pressure.
Severity of symptoms: Mild, moderate, or severe based on frequency, intensity, and impact on daily life.
Plan:
Treatment approach depends on confirmed diagnosis and severity:
Conservative management: (first line)
Dietary modifications (low-fat, low-volume meals)
Pain management medications
Calcium channel blockers (may help relax the sphincter of Oddi)
Endoscopic sphincteroplasty (considered for confirmed and severe SOD):
Minimally invasive procedure to widen the opening of the sphincter of Oddi during ERCP.
Surgery (rarely used): Sphincterotomy (surgical incision) may be considered in exceptional cases.
Follow-up:
Regular follow-up appointments to monitor symptom response, treatment adherence, and potential complications.
Repeat imaging studies (if indicated) to assess response to treatment.
Patient education: Provide information about SOD, its causes, limitations of diagnostic tests, and treatment options.
Discuss the importance of dietary modifications and lifestyle changes.
Manage expectations regarding potential treatment outcomes.
Encourage open communication about any questions or concerns.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of Sphincter of Oddi dysfunction.