Gallbladder

Question 0

Pathophysiology of a biliary colic? Triggered by? Accompanied symptoms? Signs that are not seen? Time course? Can be aborted by?

Answer 0

Stone temporarily occludes cystic duct; nausea and vomiting; no signs of peritoneal irritation or systemic signs of inflammatory process; 10-30 minutes; anti-cholinergics

Question 1

Ethnicities that have a higher incidence of gallstones?

Answer 1

Native Americans and Mexican-Americans

Question 2

Radiation of pain from biliary colic extends to?

Answer 2

Right shoulder and back

Question 3

Acute cholecystitis (versus Biliary colic)? Time course? Associated findings? Effect on LFTs?

Answer 3

Occlusion cystic duct by stone, and stone remains in cystic duct until inflammatory process develops

Constant pain, fever and leukocytosis, signs of peritoneal irritation

No changes

Question 4

HIDA scan shows uptake in liver, common bile duct, duodenum, but not in gall bladder – diagnosis?

Answer 4

Cholecystitis

Question 5

Management of acute cholecystitis? If no response? Who is likely to have no response?

Answer 5

1. NPO, NG tube, IV fluids
2. Antibiotics
3. After cooldown phase, elective cholecystectomy

Emergency cholecystectomy; diabetics and men

Question 6

Gallbladder obstruction that affects older patients with temperature spikes and very high WBC counts? Management?

Answer 6

Acute ascending cholangitis

1. IV antibiotics
2. emergency decompression (ERCP, or percutaneous transhepatic cholangiogram)
3. Followed with cholecystectomy

Question 7

Gallstone pancreatitis - stone impacted where?

Answer 7

Ampulla