Cholelithiasis and Cholecystitis

Question 1

Risk for gallstones?

Answer 1

• increases with age
• more females than males
• clusters in family (dietary)
• obesity
• multiparity

Question 2

components of most gallstones?

Answer 2

-75% are mixed stones (cholesterol, bile salts and lecithin)

Question 3

Single large stones are usually made out of?

Answer 3

cholesterol

Question 4

BLACK Pigmented stones - most common cause? usually made out of?

Answer 4

• hemolytic anemia

- calcium bilirubinate

Question 5

BROWN pigmented stones - most common cause:

-usually made out of?

Answer 5

-associated with infected bile and CBD stones (acute cholelisthiasis)
calcium bilirubinate

Question 6

What is gallbladder sludge?

Answer 6

composed of mucoprotein, cholesterol crystals and calcium bilirubinate== precursor to stones

Question 7

Which type of cholecystitis has a positive culture for bacteria?

Answer 7

Acute almost 50% of the time

Chronic about half of that

Question 8

Most common organisms to invade biliary system?

Answer 8

Most common:
-E Coli
-Klebsiella
(aerobes)
anything from GI system

Question 9

Chronic cholecystitis - symptoms:

Answer 9

• biliary colic - from obstruction
• RUQ pain with radiation to back or scapula
• nausea/Vomit
• pain resolves 1-5 hrs
• if pain >24hrs=acute cholecystitis

Question 10

chronic cholecystitis

- physical exam/symptoms

Answer 10

• pain may be absent between episodes of biliary colic
• NO PALPABLE MASS
• mild pain on deep RUQ

Question 11

acute cholecystitis - physical exam/symptoms

Answer 11

• persistent pain
• nausea and vomit common
• low grade fever - common
• pain RUQ

Question 12

positive murpheys sign with which cholecysttiis?

Answer 12

Acute

Question 13

Which cholecystitis patient LOOKS sick?

Answer 13

ACUTE

Question 14

Acute cholecystitis - PE?

Answer 14

• uncomfortable patient in constant pain
• Murpheys sign +
• tender mass may be palpable
• IF NON-TENDER = malignant
• fever,chlls, shaking, jaundice

Question 15

Lab studies - cholecystitis

Answer 15

• CBC
• electrolytes
• liver function
• amylase/llipase to rule out pancreatitis

Question 16

Test of choice for suspected cholecystitis?

Answer 16

-Ultra sound

Question 17

HIDA Scan-

Answer 17

• radionucleide scanning - that binds to bile

- for hospital - critically ill patients

Question 18

what to do with people who have asymptomatic stones?

Answer 18

just leave alone

Question 19

Chronic cholecystitis - symptoms?

Answer 19

• biliary colic is classic
• abd exam is usually benign between bouts of colic
• FEVER AND CHILLS ARE NOT PRESENT
• LABS ARE NORMAL

Question 20

Choledocholithiasis means?

Answer 20

stones in the common ducts

Question 21

cholangitis means?

Answer 21

infection in the common bile duct due to stones

Question 22

Charcot’s triad symptoms are?

Answer 22

jaundice
RUQ pain
fever with chills

Question 23

Reynolds pentad symptoms are?

Answer 23

jaundice
RUQ pain
fever with chills
(CHARCOT + additional below)…

+hypotension
+mental confusion

seen with cholangitis

Question 24

Mirizzis syndrome is?

Answer 24

large stone impaced in cystic duct obstructs common bile duct

Question 25

Tx for choledocholithiasis?

Answer 25

-surgery - removal – open or laparoscopic

Question 26

Cholangitis symptoms?

Answer 26

• reynolds pentad
• septic shock is not uncommon - these are older people who cant tolerate it = faver, chills, hypotension, tachycardia, neurologic changes

Question 27

Tx cholangitis -

Answer 27

fluids, antibiotics and some drainage

Question 28

Leading causes of pancreatitis?

Answer 28

1=alcohol

2=gallstones

Question 29

What is gallstone ileus?

Answer 29

-some larger size stone passes from duct into intestines and gets lodged somewhere