OnlineMedEd: Gastroenterology - "Gallbladder"

Question 1

The ____________ connects the gallbladder to the bile duct.

Answer 1

cystic duct

Question 2

What are the five F’s of gallstones?

Answer 2

• Fat
• Female
• Forty
• Fertile (estrogen-induced)
• Family

Question 3

In medical abbreviation, c with a line over it means _________.

Answer 3

“with”

Question 4

If the person with gallstones is not a surgical candidate, then you can prescribe _____________.

Answer 4

ursodeoxycholic acid

Question 5

You can have ____________ without having cholecystitis.

Answer 5

cholelithiasis

Question 6

Ultrasound of the gallbladders of those with cholecystitis will show what three things?

Answer 6

• Cholelithiasis
• Thickened gallbladder wall
• Pericholecystic fluid

Note: US does not usually show the obstruction!

Question 7

How will the history differ between cholelithiasis and cholecystitis?

Answer 7

Cholelithiasis presents with colicky, intermittent pain, while cholecystitis presents with constant pain.

Question 8

Describe how the HIDA scan works.

Answer 8

• In the HIDA scan, the intravenous dye will be pumped from the liver to the bile duct.
• If the cystic duct is not obstructed, then the dye will fill into the gallbladder.
• If the cystic duct is blocked, then the cystic duct will not take up dye.

Question 9

How should cholecystitis be treated?

Answer 9

• IVF
• IV abx
• NPO to prep for surgery

Question 10

Choledocholithiasis can present with two additional syndromes: ______________.

Answer 10

hepatitis (from bile duct obstruction) and pancreatitis

Question 11

True or false: those with cholelithiasis will have a positive Murphy’s sign.

Answer 11

False

Murphy’s sign is positive in those with inflammed gallbladder, so it will be positive in choleCYSTITIS.

Question 12

How is choledocholithiasis diagnosed?

Answer 12

US can show dilated bile duct, but MRCP is needed to view the obstruction.

Question 13

If the liver enzymes go up and down cyclically in a patient with symptoms concerning for choledocholithiasis, then ____________.

Answer 13

there is probably a ball-valve effect happening with the gallstone (it is going up and down, periodically blocking the flow)

Question 14

Cholangitis is usually caused by what types of bacteria?

Answer 14

• GNR

* Anaerobes

Question 15

What is the triad that suggest cholangitis (both the symptoms and the name!)?

Answer 15

Charcot’s triad:
•Fever
•RUQ pain
• Jaundice

Bonus points: Reynold’s pentad is this with hypotension and AMS.

Question 16

How is the diagnosis and treatment of cholangitis different from choledocholithiasis?

Answer 16

Both start with an US to rule out cholecystitis. If the US is negative and the person has Charcot’s triad or Reynold’s pentad, then you skip MRCP and HIDA and move straight to ERCP to remove the blockage. IVF and abx are still given.

Question 17

People often give Zosyn (pip/taxo) for cholangitis, but the best is actually _______________.

Answer 17

ciprofloxacin and metronidazole or amp/gent and metronidazole