72. Cholecystitis Flashcards Preview

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Flashcards in 72. Cholecystitis Deck (20)

cholecystitis?? (usually from )

acute or chronic inglammation of galbladderusually from cholelithiasis ( stone at neck og gallbladder) with gallbladder wall thickening


causes of cholecystitis

1. gallstones most commonly blocking the cyst duct -->2ry infection
2. rarely acalculous due to ischemia and stasis
3. 1ry infenction ( CMV)


cholecystitis diagnose with

ultrasounf or cholescintigraphy ( HIDA, or heatobiliary iminodiacetic acid scan )


cholecystitis - clinical signs ( explain )

murphy sign --> inspiratory arrest on RUQ palpation due to pain


cholecystitis with increased ALP?

bile duct becomes involved ( eg. ascending cholangitis)


acute cholecystitis - presentation

RUQ pain, often radiating to right scapula, fever ( with increased WBC), nausea boimiting


chronic cholecystitis is due to

chemical irritation from lognstanding cholelithiasis , with or with superimposed bouts oF acute cholecystitis


chronic cholecystitis

vague RUQ pain, esp after eating


chronic cholecystitis

herniation of gallbladder mucosa into muscular wall ( Rokitansky- Aschoff sinus)


cholecystitis - complications

1. fistula betwen gallbladder and gastrointestinal tract
2. porcelain gallbladder ( chronic)
3. risk of ruptured if untreated ( acute


porcelain gallbladder - mechanism and treatment

calcified gallbladder due to chronic cholecystitis ( found incidentally)
treatment : prophylactic cholecystecotomy due to high rates of gallbladder cancer ( mostly adenocarcinoma)


fistula between gallbladder and gastrointestinal tract -->

air in biliary tree ( pneumobilia) and passage og gallstones into intestinal tract --> obstruction of ileocecal calce ( gallstone ileus )


Mirizzi's syndrome is a rare complication in which

gallstone in cystic duct of gallbladder --> compression of the common bile duct common heaptic duct --> obstruction and jaundice


gallbladder carcinoma- type origin, presentation , prognosis

- adenocarcinoma from glanural epithelium ( wall)
-risk factor : gallstones ( esp if procelain gallbladder), primary sclerosing cholangitis
-present as cholecystitis in an elderly woman
-poor prognosis


billiary atresia - mechanism , presentation

failure to form or early destruction of EXTRAhepatic biliary tree --> biliary obstruction wwithin 2 monts of life --> jaundice --> cirrhosis


• A patient presents with abdominal pain. On deep palpation of the right upper quadrant, she appears to hold her breath. Name this finding.

Positive Murphy sign (inspiratory arrest on deep palpation) indicative of cholecystitis


• Name three possible causes of cholecystitis.

Gallstones (most common), infection (either 2° to spread or 1° cytomegalovirus [uncommon]), and ischemia


• If the bile duct becomes involved in a patient with cholecystitis, what lab value would you observe to be increased?

Alkaline phosphatase (ALP)


• ____ is inflammation of the gallbladder, whereas ____ is inflammation of the bile duct.

Cholecystitis, cholangitis


• A patient who you think has chronic inflammation of the gallbladder should be diagnosed using what method?

Ultrasound or HIDA scan

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