EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS Flashcards Preview

Gastrointestinal System > EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS > Flashcards

Flashcards in EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS Deck (36)
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1
Q
What is unique about the Gallbladder in terms of its anatomy?
A
Enlarges as it approaches the skin
2
Q
Where is the Gallbladder best found?
A
- Right costal margin in the mid-clavicular line
- RLQ
- Tip of right 11th rib
3
Q
What is the normal function of the gallblodder?
A
Stores and concentrates bile
4
Q
What mediates the muscular contraction and sphincter opening of the Gallbladder?
A
CCK (made in duodenum)
5
Q
Where does Gallbladder pain radiate to?
A
- Right back
- Shoulder
6
Q
Why does the Gallbladder pain radiate to the back and shoulder?
A
Viscerosomatic reflexes
7
Q
What are the risk factors for gallstone formation?
A
1) Age
2) Female
3) Family hx
4) Native American
5) Obesity
6) Multiparity
7) Rapid weight loss
8) Hemolytic disease
9) Alcohol
10) Estrogen
11) TPN
12) Cholesterol binding resins
8
Q
What are the different types of gallstones?
A
- Cholesterol-mixed
- Pigmented
- Sludge
- Single large
9
Q
What is the composition of a cholesterol-mixed gallstones?
A
- Cholesterol
- Bile salts
- Lecithin
10
Q
What is a pigmented gallstones composed of?
A
Calcium bilirubinate
11
Q
What is sludge?
A
- Mucoprotein
- Calcium bilirubinate
- Cholesterol
12
Q
What composes a single large gallstones?
A
Cholesterol
13
Q
What causes the undulating pattern of gallbladder pain seen with gallstones?
A
1) CCK induced let down
2) Stone obstructs and then FALLS back
14
Q
Where do gallstones commonly stick?
A
Common bile duct
15
Q
What are the signs and symptoms of gallstones?
A
- RUQ pain
- Worse after eating (high fat food)
- Murphy's sign +
16
Q
What are the clinical types of cholecystitis?
A
- Acute
- Chronic
- Ascending cholangitis
17
Q
What are the signs of acute cholecystitis?
A
1) Unrelenting pain
2) Fever
3) RUQ pain
4) Ass. nausea and vomiting
18
Q
What are the signs of chronic cholecystitis?
A
Intermittent pain and well between bouts
19
Q
What is Ascending Cholangitis?
A
Infection of the small intestine ascending into the biliary tree
20
Q
What is a calculous gallstones?
A
US positive stone
21
Q
What is an acalculous stone?
A
US negative for stone but positive for:
- Thickened BW wall
- Fluid in GB fossa
22
Q
What is a positive sonographic Murphy's Sign?
A
Murphy reproduced with US probe
23
Q
What labs can be elevated in cholecystitis?
A
- Total bilurubin
- Lipase if obstruction leads to pancreatitis
24
Q
How is cholecystitis treated?
A
1) NPO
2) Hydration
3) Pain control w/ Ketorolac
25
Q
What warrants admission with cholecystitis?
A
1) Impacted stone
2) Septic
3) Unrelenting pain
4) Mimic or uncertain
26
Q
What do you do if there is a negative US and clinical suspicion of gallstone?
A
HIDA
27
Q
What is a HIDA scan?
A
Nuclear med. functional study of the hepatobillary tree
28
Q
What are abnormal findings on a HIDA scan?
A
1) Non-filling i.e. obstruction
2) Non-emptying i.e. porcelain gallbladder
3) CCK sx.
29
Q
What are some of the medical therapies for cholecystitis?
A
1) Ursodiol--decrease cholesterol absorption
2) ESWL shock waves
3) Contact dissolution
30
Q
What are the quasi medical therapies for cholecystitis?
A
1) ERCP
2) Transcutaneous drain
31
Q
What are the surgical procedures for cholecystitis?
A
1) Cholecystectomy
2) ERCP
32
Q
What do you need to remember about the elderly and cholecystitis?
A
- Atypical presentation
- High mortality
33
Q
List some of the conditions that mimic cholecystitis.
A
- Acute inferior wall MI
- Subdiaphragmatic abscess
- RLL pneumonia
- Appendicitis
- Hepatitis
- Pericarditis
- PUD
- Pancreatitis
34
Q
What are the important complications of gallstones to keep in mind?
A
1) Gallstone ileus (Gallstone-->obstruction)
2) Gallstone pancreatitis
35
Q
What is Charcot's triad of cholangitis?
A
1) Jaundice
2) Fever
3) RUQ pain
36
Q
What should you do if patient comes to the ED with a surgical complication?
A
Call the surgeon