Gallbladder Flashcards
How can you treat cholelithiasis?
Avoid triggers
NSAIDs can help: diclofenac
Cholecystectomy indicated for significant symptoms or
– calcified GB, gallstones >3 cm, Native American, candidate for bariatric surgery or cardiac transplantation
Those who cannot have surgery = ursodeoxycholic acid for 2 years
whats the treatment for acute cholecystitis?
All should be admitted with no oral feeding - NPO, IV fluids, pain control with NSAIDs (ketorolac), opioids AND:
IV antibiotics: 2nd/3rd gen cephalosporin (ceftriaxone, cefazolin, cefuroxime, cefotaxime) + metronidazole
OR fluoroquinolone + metronidazole for severe cases
Cholecystectomy within 24 hours of admission
how do you treat choledocholithiasis
ERCP - endoscopic retrograde cholangiopancreatography (upper GI endoscope + XR to treat problem), remove stone, follow with lab cholecystectomy
How do you treat acute cholangitis?
Endoscopic emergency!
Admit!
Urgent ERCP w/ stone extraction
check liver function prior
Ciprofloxacin + metronidazole
Severe disease:
IV pip/taz OR carbapenem
Emergent decompression of bile duct via ERCP for septic patients or those who fail to improve with abx after 12-24 hours
Lab cholecystectomy
how do you treat primary sclerosing cholangitis?
IV ciprofloxacin
Strictures = endoscopic procedure w/ dilation or stent placement
Cholecystectomy
Liver transplant for patients w/ cirrhosis and clinical decompensation
