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
- 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
- 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
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
- Pigmented
- Sludge
- Single large
9
Q
What is the composition of a cholesterol-mixed gallstones?
A
- Cholesterol
- Bile salts
- Lecithin
- 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
- 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
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 +
- Worse after eating (high fat food)
- Murphy's sign +
16
Q
What are the clinical types of cholecystitis?
A
- Acute
- Chronic
- Ascending cholangitis
- 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
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
- 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
- Lipase if obstruction leads to pancreatitis
24
Q
How is cholecystitis treated?
A
1) NPO
2) Hydration
3) Pain control w/ Ketorolac
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
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.
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
2) ESWL shock waves
3) Contact dissolution
30
Q
What are the quasi medical therapies for cholecystitis?
A
1) ERCP
2) Transcutaneous drain
2) Transcutaneous drain
31
Q
What are the surgical procedures for cholecystitis?
A
1) Cholecystectomy
2) ERCP
2) ERCP
32
Q
What do you need to remember about the elderly and cholecystitis?
A
- Atypical presentation
- High mortality
- 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
- 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
2) Gallstone pancreatitis
35
Q
What is Charcot's triad of cholangitis?
A
1) Jaundice
2) Fever
3) RUQ pain
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
