Cholecystitis

Question 1

what is unique about the relationship of the gall bladder and the skin?

Answer 1

enlarges as it approaches the skin

Question 2

where is the gall bladder found on physical diagnosis?

Answer 2

right costal margin, mid-clavicular
RLQ
tip of 11th rib

Question 3

when is the gall bladder best palpated?

Answer 3

lying closest to skin

Question 4

what is the action of CCK on ghrelin?

Answer 4

inhibition

Question 5

what is action of CCK on beta cells / insulin?

Answer 5

induces beta cell proliferation, inhibits insulin induced hypherphagia

Question 6

do statins induce stone formation?

Answer 6

no

Question 7

what is murphys sign of diaphragmatic splinting?

Answer 7

pain upon deep inspiration

Question 8

what is the significance of presence of stones in the absence of symptoms?

Answer 8

none

Question 9

what are the signs and symptoms of acute cholecystitis?

Answer 9

unrelenting pain, often febrile

RUQ tender, N&V common

Question 10

what are the signs and symptoms of chronic cholecystitis?

Answer 10

intermittent, often after fatty meal

well between bouts

Question 11

what are the signs and symptoms of ascending cholangitis?

Answer 11

exquisite RUQ pain, peritoneal signs

signs of sepsis

Question 12

unrelenting pain, often febrile

RUQ tender, N&V common

Answer 12

acute cholecystitis

Question 13

intermittent, often after fatty meal

well between bouts

Answer 13

chronic cholecystitis

Question 14

exquisite RUQ pain, peritoneal signs

signs of sepsis

Answer 14

ascending cholangitis

Question 15

how are calculous stones imaged on US?

Answer 15

shadowing object (single, multiple, or sludge)

Question 16

what is a sonographic murphys sign?

Answer 16

symptoms reproduced by pressure on probe at gall bladder

Question 17

how are acalculous stones imaged on US?

Answer 17

negative for US shadowing

thickened GB wall, fluid in GB fossa

Question 18

what are the main complications of gall stones?

Answer 18

gallstone ileus
gallstone pancreatitis
charcot’s triad dx of cholangitis

Question 19

what is the mechanism for gallstone ileus?

Answer 19

large stone erodes GB wall into small bowel

obstruct ileocecal valve

Question 20

what is the mechanism for gallstone pancreatitis?

Answer 20

stone lodges in pancreatic opening
medical stabilization
ERCP later

Question 21

what is the presentation for charcot’s triad dx of cholangitis?

Answer 21

jaundice
fever
RUQ pain

Question 22

large stone erodes GB wall into small bowel

obstruct ileocecal valve

Answer 22

gallstone ileus

Question 23

stone lodges in pancreatic opening
medical stabilization
ERCP later

Answer 23

gallstone pancreatitis

Question 24

jaundice
fever
RUQ pain

Answer 24

charcot’s triad dx of cholangitis

Question 25

what test can differentiate stones, sludge, polyps, cancers?

Answer 25

US

Question 26

acute cholecystitis is caused by what in 90% of cases?

Answer 26

gallstones

Question 27

when is HIDA indicated?

Answer 27

if US is negative and clinical suspicion is still high

Question 28

what is the general treatment for acute cholecystitis?

Answer 28

NPO
hydration
pain control

Question 29

what indicates an abnormal HIDA scan?

Answer 29

no filling of GB

Question 30

what test is used if US is negative and clinical suspicion is still high?

Answer 30

HIDA