acute cholecystitis

Question 1

definition

Answer 1

inflam of the gallbladder caused by stone lodged in cystic duct

Question 2

risk factors

Answer 2

women, obese, increased age, highest in mex/americans, hypertriglyceridemia may promote gallstones

Question 3

cause

Answer 3

gets signal to secrete bile to help w/ digestion, gallbladder contracts and stone gets stuck, as the stuck increases bile becomes an irritant, mucosa secretes mucus and enzymes, bacterial growth starts

Question 4

S&S

Answer 4

pain starts in epigastric then RUQ radiates to shoulder, dull achy pain
peritonitis
fever
leukocytosis
vomit
rebound tenderness/guarding
jaundice
\+ murphys sign

Question 5

where does pain start and then radiate to

Answer 5

starts in the epigastric area, then RUQ radiates to the shoulder

Question 6

quality of pain

Answer 6

dull achy

Question 7

diagnosis

Answer 7

US confirms, HIDA, ercp, mrcp, ct

Question 8

US confirms by seeing what

Answer 8

sludge, bile duct distention, gallbladder wall thickening

Question 9

diff

Answer 9

perforated peptic ulcer, acute pancreatitis, appy, perforated diverticulum, liver abscess, hepatitis, pna, myocardial ischemia

Question 10

complications

Answer 10

gangrene and chronic cholecystitis

Question 11

when does gangrene happen

Answer 11

24-48 hrs suggest severe inflammation and poss gangrene which can lead to perforation and abscess

Question 12

treatment

Answer 12

Admit: npo, ivf, anagesic
iv abx: 2nd/3rd gen: cephalosporin: + flagyl
admit
monitor for gangrene, US guided aspiration delay sx, cholecystectomy within 24 hrs of admit