Flashcards in ACUTE ABDOMEN Deck (27):
What are the differential diagnoses for right upper hypochondrium pain?
What are the four main causes of hepatitis?
Toxins (eg Paracetamol)
What is the triad associated with ascending cholangitis?
What is biliary colic?
Biliary colic is the term used to describe a type of pain related to the gallbladder that occurs when a gallstone transiently obstructs the cystic duct and the gallbladder contracts.
How might you differentiate cholecystitis in an acute abdomen from something like ascending cholangitis or choledocholithiasis?
Murphy's sign - get patient to breath out. Place hand under rib cage in mid-clavicular line and then get patient to breath in. A positive sign is if the patient 'catches' with pain as they breath out. A positive sign is associated with cholecystitis.
What is ascending cholangitis?
An infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones.
What will blood tests in someone with ascending cholangitis show?
How is someone with ascending cholangitis treated?
Broad spectrum antibiotics and those that can target gram negative bacteria - cephalosporins, metranidazole, aminoglycosides (gentamicin)
What is choledocholithiasis?
A gall stone anywhere between the exit of the gall bladder and the ampullae (the biliary tree).
What might precipitate biliary colic?
Eating fatty foods
How long does a classic bout of biliary colic last?
Can be 5-10 minutes but often lasts more than 30 mins.
Where does biliary colic pain radiate?
Radiates to the back and shoulder and across the epigastrium.
What is cholelithiasis?
Gallstones in the gall bladder
Is fever associated with biliary colic?
What do blood tests in someone with biliary colic show?
Normal ranges for LFTs.
What is the treatment for biliary colic?
Often only symptomatic relief unless there is evidence of underlying liver damage.
What is cholecystitis?
Inflammation of the gallbladder most often caused by cholelithiasis.
What are the common symptoms of cholecystitis?
Persistent sharp pain
Radiating to shoulder
Worse on inspiration
Loss of appetite
How is cholecystitis treated?
Broad spectrum antibiotics if infection is suspected
Cholecystectomy to prevent recurrence and complications
What are the risk factors for cholecystitis and gallstones?
Ethnicity (Native North American)
Rapid weight loss
What are the possible complications associated with cholecystitis?
Too much calcium in the gallbladder will increase the risk of cancer
What will blood tests of someone with cholecystitis show?
Normal or very mildly raised bilirubin (if too high an additional or alternative diagnosis should be sought)
Mildly abnormal liver tests
What investigations would you do in someone suspected of having cholecystitis?
Other imaging includes: X-ray, MRI or CT
What are most gallstones made of?
What are black gallstones?
Which gallstones show up on x-ray?