Cholelithiasis Flashcards Preview

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

Flashcards in Cholelithiasis Deck (41):
1

When do you recommend surgery for gall stones?

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

Three episodes in a year

2

What is a cholecystostomy?

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

3

What is the normal diameter of the CBD?

2mm + 1mm/decade of life

4

What is the classic symptomatology of biliary colic?

RUQ pain (+/- to back)

Typically following a fatty meal

Constant pain that eventually recedes

+/- N/V

5

How do you differentiate cholecystitis from biliary colic?

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

6

What is Charcot's triad?

Fever

Jaundice

RUQ Pain

7

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

Prophylaxis

 

Ceftriaxone

Metronidazole

8

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

Cholesterol

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

 

9

When do you operate for cholecystitis?

As soon as possible

10

What are some US findings for cholecystitis?

Enlarged

Thickened wall

Stones, perhaps in Hartman's pouch

Rule out empyema, abscess

11

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

Decrease in bilirubin and liver enzymes

12

How is acute cholecystitis managed?

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

13

For which disease is Murphy's sign most sensitive?

Cholecystitis

14

What are some symptoms of cholecystitis?

Constant (>12 hours) RUQ pain

Fever

15

How does the pain of biliary colic and cholecystitis differ?

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

16

Why doesn't Xray play a role in choleliathiasis?

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

17

How do you managed cholecystitis non-surgically?

Abx

Anti-pyretics

Analgesia

Cholecystostomy (radiological drainage of GB)

18

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

Choledocholithiasis

19

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

Mucocele

20

What is gallstone ileus?

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

What is chronic cholecystitis caused by?

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

22

What are some symptoms of gall stones?

RUQ pain

Anorexia

N/V

 

23

What is unique about cholangitis?

Rigors

24

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

20%

1-4%

25

How is choleliathiasis managed?

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

How does cholangitis typically present on hx?

Charcot's triad: 

Fever

Jaundice

RUQ pain - can radiate to the tip of the shoulder

27

What type of inflammation occurs in cholecystitis?

Chemical inflammation

28

What are some DDx of cholelithiasis complications?

Pancreatitis

Peptic ulcers

Hepatitis

Appendicitis

Malignancy of surrounding viscera

29

What are some factors that predispose one to developing cholelithiasis?

Female, fat, forties, and fertile

Hyperlipidaemia and hypercholesterolaemia

FHx

Increasing age

Cholestatis - spinal cord injury

30

How does pancreatitis pain differ from cholelithiasis related pain?

It is more severe

Epigastric, sometime radiating to the back

Sharp and continuous

31

What are some definitive treatment methods for cholangitis?

ERCP

GB exploration (if performing cholecystectomy)

32

Why is a CTIVC better than an MRCP?

Because it gives a indication of excretory function

33

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

CT IVC (cholangiography)

Biliscopin

When the bilirubin is >30

34

What are some types of gall stones?

Cholesterol

Calcium/bilirubin

35

What is Reynold's pentad?

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

Shock

Confusion

36

When are endoscopic retrograde sphincterotomy's indicated?

When a cholecystectomy wouldn't be tolerated

To remove gall stones left after a previous cholecystectomy

37

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

6hours

38

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

If 5-10mm monitor

If >10mm intervene

39

What is gallstone ileus?

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

40

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

Ceftriaxone + metronidazole

>

Tazocin

41

What is Mirizzi's syndrome?

CBD obstruction due to a stone in Hartmann's pouch