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Gallbladder Flashcards

1
Q

Pt presents with steady pain in the RUQ for the last 4 hours associated with N,V, and fever.

A

acute cholecystitis

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2
Q

if a pt presents with jaundice, light colored stools, and dark tea colored urine what do they have

A

extrahepatic biliary obstruction

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3
Q

how does a pt with biliary colic present vs acute cholecystitis

A

biliary colic-uncomfortable and restless

cholecystitis-still because pain is aggravated by movement

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4
Q

what is murphy’s sign and what is it associated with

A

cessation of inspiration due to pain on deep palpation of the ruq when the visceral peritoneum overlying the gallbladder is inflamed

acute cholecystitis

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5
Q

courvoisier’s sign

A

nontender palpable gallbladder w jaundice that suggests underlying malignant disease such as carcinoma of the pancreas

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6
Q

what lab tests should be obtained

A 
LFTs
serum level of unconjugated bilirubin (hemolytic disorders);conjugated (extrahepatic obstruction)
alkaline phosphatase (ALP)- syn by biliary tract epithelium; differentiate it from bone by heat stability or elevation of GGT (ALP/GGT >AST/ALT)
INR- elev in pts w obstructive jaundice from malabsorption of vit K
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7
Q

what is the initial study of choice for pts w biliary disease

A

US

stones as small as 3mm in diameter

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8
Q

what does the finding of thickened gallbladder wall or pericholecystic fluid suggest

A

acute cholecystitis

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9
Q

how does the radionuclide biliary scan (HIDA scan) work

A

IV injection of 99techneitum derivative-> radionuclide excreted by the liver into bile in high concentrations –> enters gallbladder and duodenum

normal gallbladder begins to fill in 30m; if cant visualize common bile duct and duodenum wout filling of gallbladder in 4hr=cystic duct obstruction=acute cholecystitis

not useful for showing stones in either the gallbladder or common bile duct

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10
Q

leukocytosis,left shift, mild inc in AST/ALT/ALP, mild hyperbilirubinemia

A

acute cholecystitis

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11
Q

what is the initial management of acute cholecystitis

A

withholding oral intake
administering iv fluids
abx therapy

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12
Q

what bacteria is commonly assoc w acute cholecystitis

A

e choli
klebsiella
streptococcus faecalis

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13
Q

what is the tx for pts w acute cholecystitis who are poor surgical candidates

A

cholecystostomy- percutaneous placement of a tube under us guidance through the liver into the gallbladder to drain its contents

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14
Q

what is acute emphysematous cholecystitis

A

result from gas forming bacteria

will see air on xray

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15
Q

biliary colic, n, v, intolerance to fatty foods, flatulence, belching and indigestion; no fever or chills

A

chronic cholecystitis

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16
Q

management of an episode of biliary colic

A

analgesics and observations

after cholelithiasis is confirmed, the optimum tx is elective cholecystectomy

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17
Q

oral dissolution therapy

A

ursodeoxycholic acid taken for 6m-1yr

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18
Q

gallstones that pass through the cystic duct and enter common bile duct

A

choledocholithiasis

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19
Q

pt presents with jaundice, light colored stools and dark tea colored urine

A

obstruction of the bile duct

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20
Q

characterized y charcots triad

A

acute cholangitis

charcots- jaundice, ruq pain, fever

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21
Q

acute suppurative cholangitis

A

infx accompanying acute cholangitis that progresses to presence of pus in biliary ducts

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22
Q

presents with reynolds pentad

A

acute suppurative cholangitis

reynolds- ruq pain, jaundice, fever, hypotension, mental confusion

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23
Q

mirizzi’s syndrome

A

large stone in the gallbladder compresses the common hepatic duct that can lead to obstructive jaundice

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24
Q

lab results for cholangitis

A

leukocyte count elev
total bili elev
serum ALP/GGT marked elev
AST/ALT mild elevations

25
management of acute cholangitis
``` urgent intervention hydrated w IV fluids abx bowel rest blood cx ```
26
why are gallstones a common cause of pancreatitis
transient or persistent obstruction of the ampulla of Vater by a large stone or passage of small stones and biliary sludge
27
management of pts w acute biliary pancreatitis
resuscitation supportive care correction of any fluid deficits
28
when can a laparoscopic cholecystectomy be safely performed with mild/moderate pancreatitis
within the first 48-72hrs of admission
29
what is performed if someone with gallstone pancreatitis is a poor surgical candidate
endoscopic sphincterotomy
30
when should a cholecystectomy be performed if pt has severe pancreatitis
delayed until pancreatitis has resolved some weeks or months later but make sure pt is placed on abx
31
what is a gallstone ileus
mechanical obstruction of the intestine caused by a large gallstone that erodes through the gallbladder into the duodenum; may be assoc w pneumobilia; point of obstruction is often in the distal ileum
32
what do plain abd xray show for gallstone ileus
findings of small intestinal obstruction and may show air in the biliary tree
33
what is the preferred dx test for gallstone ileus
ct with oral contrast
34
tx for gallstone ileus
NG tube for decompression of the obstruction IV hydration surgical exploration of the abd and an enterolithotomy
35
why does gallbladder cancer occur
chronic inflammation MC from cholesterol gallstones
36
Pt with ruq pain, weight loss, malaise and jaundice
gallbladder cancer
37
what are the majority of bile duct strictures a result from and why
iatrogenic injury during an operative procedure because of limited blood supply and no redundancy
38
procedure for open common bile duct exploration
1. mobilize the duodenum w Kocher maneuver 2. id the duct and make small longitudinal incision in common bile duct 3. irrigate lumen w saline using flexible catheters to flush out stones and debris 4. inflatable balloon catheters passed prox/dist to extract stones 5. small endoscope (choledochoscope) 6. all stones and debri removed, duct is irrigated with saline 7. T tube placed in lumen of duct and opening of duct is closed around it
39
when there are multiple stones or if stones left in bile duct what is important to be done during surgery
anastomosis between bile duct and GI tract (choledochoduodenostomy or choledochojejunostomy) so that residual stones may pass easily from duct into intestine
40
when is the peritoneal drainage catheter removed after T tube has been clamped during bile duct exploration
24-48hr
41
when are T tubes removed
3-6wks
42
how are MC bile duct stones removed
ERCP and sphincterotomy
43
how is a sphincterotomy of the sphincter of Oddi performed
special cautery wire passed through the duodenoscope into the sphincter and then the common duct is cleared using special balloon catheters or wire baskets
44
41yo F w 18hrs of N, ruq pain and fever. Ate heavy meal night before. Elev WBC, normal bilirubin, slightly elev AST/ALT. Most appropriate study?
US most likely acute cholecystitis
45
51yo fever and abd pain, Temp 38.4C. tender w guarding of ruq. WBC 17000. LFs and lipase normal. US ids gallstones, gallbladder wall of 5mm, fluid surround gallbladder. what abx?
Cefoxitin MC gram neg (e coli and klebsiella) want 2/3 cephalosporin
46
83yo 2d hx n/v. abd slightly distended and nontender. norm WBC and metabolic alkalosis. abd xray show small bowel obstruction and air in biliary tree. dx?
gallstone ileus
47
54yo abd pain for 8hrs. mid abd getting worse. elev wbc, amylase 792, normal lfts. US gallstones. Management?
admit, hold intake by mouth, schedule for cholecystectomy before discharge
48
72yo yellow eyes, dark urine, light stool. diminished appetite. afebrile. jaundiced. nontender smooth globular mass consistent w enlarged gallbladder in ruq. dx?
pancreatic cancer
49
what regulates bile flow into duodenum
sphincter of Oddi which encircles the common channel
50
what makes triangle of calot
inferior margin of liver, common hepatic duct, cystic duct
51
where does most bile acid reabsorption happen
level of terminal ileum
52
what makes bile more prone to stone formation
greater losses=diminished pool= dec concentration
53
what is responsible for the green brown color of bile and brown of stool
conjugated bilirubin direct=water soluble=excreted in urine indirect=fat soluble=no urine
54
ways to prevent gallstone formation
avoid obesity, high fiber diet, eat meals at regular intervals, foods w low levels of sat fatty acids
55
MC type of gallstones
cholesterol, bile acids, lecithin (phospholipid)= cholesterol crystals
56
where is the source of most stones found in the biliary ducts (choledocholithiasis)
gallbladder
57
how is biliary colic described
steady visceral dull/aching pain lasting 1-4hrs postprandial lg/fatty meal
58
what is acute cholecystitis
acute inflammation and infection of the gallbladder

Surgery (21 decks)

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