EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS Flashcards Preview

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

Flashcards in EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS Deck (36):
1

What is unique about the Gallbladder in terms of its anatomy?

Enlarges as it approaches the skin

2

Where is the Gallbladder best found?

- Right costal margin in the mid-clavicular line
- RLQ
- Tip of right 11th rib

3

What is the normal function of the gallblodder?

Stores and concentrates bile

4

What mediates the muscular contraction and sphincter opening of the Gallbladder?

CCK (made in duodenum)

5

Where does Gallbladder pain radiate to?

- Right back
- Shoulder

6

Why does the Gallbladder pain radiate to the back and shoulder?

Viscerosomatic reflexes

7

What are the risk factors for gallstone formation?

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

What are the different types of gallstones?

- Cholesterol-mixed
- Pigmented
- Sludge
- Single large

9

What is the composition of a cholesterol-mixed gallstones?

- Cholesterol
- Bile salts
- Lecithin

10

What is a pigmented gallstones composed of?

Calcium bilirubinate

11

What is sludge?

- Mucoprotein
- Calcium bilirubinate
- Cholesterol

12

What composes a single large gallstones?

Cholesterol

13

What causes the undulating pattern of gallbladder pain seen with gallstones?

1) CCK induced let down
2) Stone obstructs and then FALLS back

14

Where do gallstones commonly stick?

Common bile duct

15

What are the signs and symptoms of gallstones?

- RUQ pain
- Worse after eating (high fat food)
- Murphy's sign +

16

What are the clinical types of cholecystitis?

- Acute
- Chronic
- Ascending cholangitis

17

What are the signs of acute cholecystitis?

1) Unrelenting pain
2) Fever
3) RUQ pain
4) Ass. nausea and vomiting

18

What are the signs of chronic cholecystitis?

Intermittent pain and well between bouts

19

What is Ascending Cholangitis?

Infection of the small intestine ascending into the biliary tree

20

What is a calculous gallstones?

US positive stone

21

What is an acalculous stone?

US negative for stone but positive for:
- Thickened BW wall
- Fluid in GB fossa

22

What is a positive sonographic Murphy's Sign?

Murphy reproduced with US probe

23

What labs can be elevated in cholecystitis?

- Total bilurubin
- Lipase if obstruction leads to pancreatitis

24

How is cholecystitis treated?

1) NPO
2) Hydration
3) Pain control w/ Ketorolac

25

What warrants admission with cholecystitis?

1) Impacted stone
2) Septic
3) Unrelenting pain
4) Mimic or uncertain

26

What do you do if there is a negative US and clinical suspicion of gallstone?

HIDA

27

What is a HIDA scan?

Nuclear med. functional study of the hepatobillary tree

28

What are abnormal findings on a HIDA scan?

1) Non-filling i.e. obstruction
2) Non-emptying i.e. porcelain gallbladder
3) CCK sx.

29

What are some of the medical therapies for cholecystitis?

1) Ursodiol--decrease cholesterol absorption
2) ESWL shock waves
3) Contact dissolution

30

What are the quasi medical therapies for cholecystitis?

1) ERCP
2) Transcutaneous drain

31

What are the surgical procedures for cholecystitis?

1) Cholecystectomy
2) ERCP

32

What do you need to remember about the elderly and cholecystitis?

- Atypical presentation
- High mortality

33

List some of the conditions that mimic cholecystitis.

- Acute inferior wall MI
- Subdiaphragmatic abscess
- RLL pneumonia
- Appendicitis
- Hepatitis
- Pericarditis
- PUD
- Pancreatitis

34

What are the important complications of gallstones to keep in mind?

1) Gallstone ileus (Gallstone-->obstruction)
2) Gallstone pancreatitis

35

What is Charcot's triad of cholangitis?

1) Jaundice
2) Fever
3) RUQ pain

36

What should you do if patient comes to the ED with a surgical complication?

Call the surgeon