Cholelithiasis and Cholecystitis

Question 1

What is the only structures that enlarges as it approaches the skin?

Answer 1

Gallbladder

Question 2

What is the location of the gallbladder?

Answer 2

Right costal margin at the midclavicular line

Question 3

GB concentrations are stored bile how?

Answer 3

Lecithin concentrates it to a supersaturated solution

Question 4

What is the hormone that causes the gallbladder to squeeze?

Answer 4

CCK

Question 5

Where is CCK made? What causes it to be secreted?

Answer 5

Duodenum

Fatty meals

Question 6

What is the effect of CCK in the brain?

Answer 6

Induce satiety

Inhibits hunger sensation

Question 7

CCK inhibits the action of what hormone?

Answer 7

Ghrelin

Question 8

What is the effect of CCK on beta-cell proliferation?

Answer 8

Induces it

Question 9

What is the cause of visceral referral pattern of cholecystitis?

Answer 9

Right should blader d/t phrenic nerve

Question 10

Who usually gets gallstones?

Answer 10

Fair
Fat
Female
Fertile

Question 11

Do statins induce stone formation?

Answer 11

No

Question 12

What drugs induce stone formation?

Answer 12

Bile sequestrants

Question 13

What percent of the population has gallstones?

Answer 13

10%

Question 14

What is the composition of gallstones?

Answer 14

Cholesterol
Bile salts
Lecithin
Cabilirubinate

Question 15

Black gallstones indicate what? Brown?

Answer 15

Black = hemolytic disease
Brown = Infection

Question 16

What causes choledocholithiasis?

Answer 16

GB wall contraction with obstruction of gallstone

Question 17

Why is there only referred pain with early cholecystitis?

Answer 17

Not hitting peritoneum

Question 18

What is the symptoms that aggravate cholecystitis?

Answer 18

Breathing in deeply

Eating

Question 19

Fever and chills with usual RUQ pain = ?

Answer 19

Sepsis secondary to cholecystitis

Question 20

What fraction of pts with stones never have symptoms?

Answer 20

2/3

Question 21

What are the ssx of acute cholecystitis?

Answer 21

unrelenting, RUQ pain
Fever
n/v

Question 22

What are the ssx of chronic cholecystitis?

Answer 22

Intermittent, often after fatty meals

Question 23

What are the ssx of ascending cholangitis?

Answer 23

Exquisite RUQ pain, Peritoneal signs

Signs of sepsis

Question 24

What are the US findings of the gallbladder with cholelithiasis?

Answer 24

may show free, impacted, or distal stones

Question 25

What does it mean to be acalculus?

Answer 25

Cholecystitis but without a visible gallstone on US

Question 26

What is the sonographic Murphy's sign?

Answer 26

Symptoms reproduce by pressure on probe

Question 27

What are the complications of gallstones?

Answer 27

Gallstone ileus | Gallstone pancreatitis

Question 28

What are the labs that are elevated with cholecystitis? (3)

Answer 28

Alk phos Total bili Lipase if pancreatitis

Question 29

What is the next scan to order if the US is negative for gallstones?

Answer 29

HIDA scan

Question 30

What is the general treatment of cholelithasis?

Answer 30

Pain control NPO IVF (LR) abx if septic

Question 31

When should pts with gallbladder issues be admitted?

Answer 31

Septic | impacted stone

Question 32

What is a HIDA scan?

Answer 32

Nuclear med functional study, with injection of technetium into gallbladder, with CCK injected later to cause contraction

Question 33

What are the three abnormal findings of a HIDA scan?

Answer 33

- Non-filling (obstructed) - Non-emptying (non-functional) - Symptoms with CCK

Question 34

What is Ursodiol?

Answer 34

Drug that decreases cholesterol absorption

Question 35

What is ESWL?

Answer 35

Shock waves into gallbladder to break up stones

Question 36

What is the surgical treatment for cholecystitis?

Answer 36

Laparoscopic cholecystectomy

Question 37

What is it a surgical emergency to remove a gallbladder?

Answer 37

Ascending cholangitis

Question 38

What is ERCP?

Answer 38

Endoscopic retrograde cholangio pancreatoscopy

Question 39

What are the emergent causes of cholecystitis?

Answer 39

- Infectious causes (ascending cholangitis) - Gallstone pancreatitis - Extremes of age

Question 40

What is Charcot's triad of cholangitis?

Answer 40

Jaundice Fever RUQ pain

Question 41

What type of bacteria usually causes cholangitis?

Answer 41

Gram negative

Question 42

How do surgeons ensure that there are no stones after the gallbladder is removed?

Answer 42

Intraoperative cholangiogram

Question 43

What are the medical treatments for cholecystitis?

Answer 43

Ursodiol ESWL (shock waves) Contact dissolution

Question 44

The common cystic duct is a union between which two ducts?

Answer 44

Common hepatic | Common bile

Question 45

What is the combination of cholesterol, bile salt, and lecithin that leads to cholesterol solution, rather than cholesterol stones?

Answer 45

Low cholesterol High lecithin High bile salts