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Hugh's MD2 Core Conditions and Presentations > Cholelithiasis > Flashcards

Cholelithiasis Flashcards

1
Q

When do you recommend surgery for gall stones?

A

A second episodes of symptoms within 3 months of the first episode

Three episodes in a year

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2
Q

What is a cholecystostomy?

A

Surgical placement of a drain to remove pus in a gallbladder empyema and sepsis in order to stabilise a patient prior to definitive cholecystectomy

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3
Q

What is the normal diameter of the CBD?

A

2mm + 1mm/decade of life

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4
Q

What is the classic symptomatology of biliary colic?

A

RUQ pain (+/- to back)

Typically following a fatty meal

Constant pain that eventually recedes

+/- N/V

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5
Q

How do you differentiate cholecystitis from biliary colic?

A

The pain is constant and will not go away at any point, if it does go away then it’s biliary colic

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6
Q

What is Charcot’s triad?

A

Fever

Jaundice

RUQ Pain

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7
Q

Why do you use Abx in cholecystitis? Which ones do you use?

A

Prophylaxis

Ceftriaxone

Metronidazole

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8
Q

What is the most common type of gall stone? How do they form?

A

Cholesterol

Supersaturation of cholesterol in the gall bladder in a area of stasis and precipitation into stones

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9
Q

When do you operate for cholecystitis?

A

As soon as possible

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10
Q

What are some US findings for cholecystitis?

A

Enlarged

Thickened wall

Stones, perhaps in Hartman’s pouch

Rule out empyema, abscess

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11
Q

How might the passing of a troublesome gall stone be reflected in laboratory findings?

A

Decrease in bilirubin and liver enzymes

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12
Q

How is acute cholecystitis managed?

A

It is considered a surgical emergency but can be managed conservatively with antibiotics and fluids

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13
Q

For which disease is Murphy’s sign most sensitive?

A

Cholecystitis

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14
Q

What are some symptoms of cholecystitis?

A

Constant (>12 hours) RUQ pain

Fever

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15
Q

How does the pain of biliary colic and cholecystitis differ?

A

Biliary colic pain is less well localised and not accompanied by tenderness and guarding

Cholecystitis pain is well localised to the RUQ and often accompanied by tenderness and guarding

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16
Q

Why doesn’t Xray play a role in choleliathiasis?

A

Only 10-30% of cholesterol and pigment stones are radio-opaque

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17
Q

How do you managed cholecystitis non-surgically?

A

Abx

Anti-pyretics

Analgesia

Cholecystostomy (radiological drainage of GB)

18
Q

Which cholelithiasis related condition presents with painless jaundice and an obstructive picture on liver enzymes?

A

Choledocholithiasis

19
Q

What is the name of the process where fluid builds up in the gallbladder secondary to an obstruction?

A

Mucocele

20
Q

What is gallstone ileus?

A

When a sufficiently large gall stone erodes through the wall of the gall bladder and travels into the duodenum down and blocks the ileum

21
Q

What is chronic cholecystitis caused by?

A

Fibrosis and loss of the function of the gall bladder due to long term stones

22
Q

What are some symptoms of gall stones?

A

RUQ pain

Anorexia

N/V

23
Q

What is unique about cholangitis?

A

Rigors

24
Q

What percentage of people have gall stones in their lifetime? What percentage of those get symptoms?

A

20%

1-4%

25
Q

How is choleliathiasis managed?

A

Medically - bile salt therapy

  • Dissolution - Ursodeoxycholic acid

Surgery - Cholecystectomy - for patients with symptomatic disease or asymptomatic if they’re at high risk of not tolerating complications

Endoscopic retrograde sphincterotomy

26
Q

How does cholangitis typically present on hx?

A

Charcot’s triad:

Fever

Jaundice

RUQ pain - can radiate to the tip of the shoulder

27
Q

What type of inflammation occurs in cholecystitis?

A

Chemical inflammation

28
Q

What are some DDx of cholelithiasis complications?

A

Pancreatitis

Peptic ulcers

Hepatitis

Appendicitis

Malignancy of surrounding viscera

29
Q

What are some factors that predispose one to developing cholelithiasis?

A

Female, fat, forties, and fertile

Hyperlipidaemia and hypercholesterolaemia

FHx

Increasing age

Cholestatis - spinal cord injury

30
Q

How does pancreatitis pain differ from cholelithiasis related pain?

A

It is more severe

Epigastric, sometime radiating to the back

Sharp and continuous

31
Q

What are some definitive treatment methods for cholangitis?

A

ERCP

GB exploration (if performing cholecystectomy)

32
Q

Why is a CTIVC better than an MRCP?

A

Because it gives a indication of excretory function

33
Q

What is the CT used for gallbladder? When is it contraindicated?

A

CT IVC (cholangiography)

Biliscopin

When the bilirubin is >30

34
Q

What are some types of gall stones?

A

Cholesterol

Calcium/bilirubin

35
Q

What is Reynold’s pentad?

A

Charcot’s triad (fever, jaundice, RUQ pain)

Shock

Confusion

36
Q

When are endoscopic retrograde sphincterotomy’s indicated?

A

When a cholecystectomy wouldn’t be tolerated

To remove gall stones left after a previous cholecystectomy

37
Q

What is the temporal cut off between biliary colic and cholecystitis?

A

6hours

38
Q

What is the course of action if a gallbladder polyp is found?

A

If 5-10mm monitor

If >10mm intervene

39
Q

What is gallstone ileus?

A

When a gallstone erodes through the bladder into the duodenum and causes obstruction, usually at the ileocaecal junction

40
Q

What are the Abx of choice for biliary infections/cholangitis?

A

Ceftriaxone + metronidazole

>

Tazocin

41
Q

What is Mirizzi’s syndrome?

A

CBD obstruction due to a stone in Hartmann’s pouch

Hugh's MD2 Core Conditions and Presentations (67 decks)

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