Gallbladder

Question 1

Charcot’s triad

Answer 1

Fever + RUQ pain + jaundice → cholangitis

Question 2

Raynaud’s pentad

Answer 2

• Fever
• RUQ pain
• jaundice
• confusion
• shock

( Cholangitis)

Question 3

Rick factors for gallstones

Answer 3

Female, fat, fertile, forty

Question 4

St5 of cholecystitis / choledocholithiasis

Answer 4

RUQ / epigastric pain, constant x hrs, severe. Murphy’s sign
Nausea /anorexia /vomiting
Low grade fever
Acholic stools, tea colored urine

Question 5

Investigations for patient presenting with RUQ/epigastic pain suggestive of gallbladder pathology

Answer 5

↑ WBC with left shift
Alt, AST, alp, conjugated bilirubin
Lipase, amylase ( to r/o pancreatitis)
Blood culture if hx suggestive of cholangitis
U/s abdomen

Question 6

U/s findings in cholecystitis

Answer 6

Thickened gall bladder wall >3mm
Pericholecystic fluid
Gallstone in cystic duct
Distended gallbladder

Question 7

Management of cholecystitis

Answer 7

NPO
Iv fluids
Ng if persistent vomiting
Analgesia
Abx ampicillin + gentamicin + metronidazole
Surgery

Question 8

Management of cholangitis

Answer 8

NPO, iv fluids, ng tube, analgesia
Antibiotics
Ercp with sphincterotomy. Can consider laparotomy

Question 9

Complication of cholecystitis

Answer 9

Biliary obstruction
Duodenal Perforation
Cholangitis / sepsis
Hepatitis, pancreatitis
Cholecyst enteric fistula