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Flashcards in gallbladder Deck (33)
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1
Q

incidence of gallstones

A

by age 75, 35% of women and 20% of men

30% of people will have symptomatic disease

2
Q

what is acute cholecystitis

A

obstruction of the bile duct, usually a stone

leads to chronic inflammation

3
Q

colicky epigastic pain or RUQ pain becoming steady and increases in intensity. often occurs after a high fat meal

*post prandial abdominal pain, assoc with N/V

A

acute cholelcystitis symptoms

4
Q

right shoulder or subscapular pain may occur with what

A

acute cholecystitis

5
Q

labs and imaging to order for acute cholecystitis

A

*HIDA scan initial and definitive test

bilirubin levels with increase after 24hrs and leukocytosis common

6
Q

HIDA scan and ERCP for what

A

gallstone

HIDA to confirm

ERCP to identify cause, location, and extent of biliary obstruction

7
Q

what is acute cholangitis

A

potentially deadly condition of common bile duct obstruction combined with ascending infection

8
Q

charcots triad

A

RUQ tenderness, jaundice, fever. occurs in 50-70% of acute cholangitis

9
Q

pt has charcots triad and also altered mental status and hypoTN

A

sepsis with acute cholangitis

10
Q

elderly presentation of acute cholangitis

A

confusion, falls, and incontinence

11
Q

how to dx acute cholangitis

initial test

labs

procedure

A

RUQ ultrasonography will show biliary dilation or stones *good initial test

leukocytosis with left shift along with increased bilirubin, elevated alk phos, and mildly increased transaminase levels support dx

ECRP(definitive) optimal procedure for dx and tx, should not be done until the pt is stable

12
Q

initial tx for acute cholangitis (3)

A

antibx (FQ, cephalosporin, ampicillin, gentamycin with flagyl)

fluid and electrolyte replacement

analgesia

13
Q

what is primary sclerosing cholangitis

A

chronic thickening of the bile duct walls of unknown etiology.

maybe stone or infection usually

14
Q

80% of primary sclerosing cholangitis is associated with what

A

inflammatory bowel disease, generally UC

10% of pts with UC will develop PSC

15
Q

gender and age of primary sclerosing cholangitis

A

male to female 7:3 age btw 21-67

16
Q

sx of primary sclerosing cholangitis

A

jaundice and pruritis most common

hepatomegaly and/or splenomegaly on exam

fatigue, malaise, wt loss

17
Q

primary sclerosing cholangitis

initial imaging

labs

2 other tests

A

RUQ ultrasonography

increased alk phos and bilirubin

leukocytosis with left shift

ERCP: “beading” mulitiple bile duct strictures

liver bx: “onion skinning” periductal sclerosis

18
Q

tx for primary sclerosing cholangitis

A

localized strictures relieved with balloon dilation and stent placement

long term stenting increases risk of cholangitis

liver transplant is the only tx with a known survival benefit

19
Q

complications of gallstones

A

cholecystitis

pancreatitis

acute cholangitis

20
Q

common cause of acute cholecystitis

imaging

A

95% due to gallstones

20% radiopaque, remainder visible on sonography

* HIDA to confirm

ERCP

21
Q

acute cholelcystitis symptoms

radiation

other mild symptoms

A

colicky epigastic pain or RUQ pain becoming steady and increases in intensity. often occurs after a high fat meal

radiation to rt shoulder or subscapular area

N/V, low fever are common

constipation and mild paralytic ileus may occur

22
Q

acute cholangitis organisms

other causes

A

E coli, enterococcus, klebsiella, enterobacter

can lead to sepsis and death

most often caused by choledocholithiasis,

or neoplasms, post op strictures, other causes of obstruction

23
Q

reynolds pentad

A

charcot triad

altered mental status

hypotension

all indicate sepsis!! fatal!!

think cholangitis

24
Q

primary sclerosing cholangitis is strongly associated with what

A

cholangcarcinoma (10-30% of pts) as well as with an increased risk of pancreatic and colorectal carcinoma

25
Q

secondary tx for acute cholangitis

A

[ECRP for drainage and cholecystectomy]

ECRP for drainage, sphincterotomy, stone removal, and stent placement when pt is stable

percutaneous transhepatic biliary drainage or surgical biliary drainage may be required

cholecystectomy should be performed after the acute syndrome is resolved when a stone is present

26
Q

4 F’s for gallstones

A

female

fat

forty

fertile

27
Q

additional risk factors:

OCP use, rapid wt loss, TPN,

chronic hemolysis(pigment stones in sickle cell disease),

small bowel resection(loss of enterohepatically circulated bile)

A

gallstones

28
Q

acute cholecystitis

symptoms(3) and exam(1)

A

RUQ pain, N/V, low fever

murphy sign

29
Q

murphy sign

A

inspiratory arrest with deep palpation of RUQ

acute cholecystitis

30
Q

risk factors:

native american

DM

pregnancy

crohns

female

obesity

A

risk factors for cholecystitis

31
Q

RUQ ultrasonography

increased alk phos and bilirubin

leukocytosis with left shift

ERCP: “beading” mulitiple bile duct strictures

liver bx: “onion skinning” periductal sclerosis

A

tests for primary sclerosing cholangitis

32
Q

why are most gallstones not radiopaque

A

cholesterol

33
Q

confusion, falls, and incontinence

A

elderly presentation of acute cholangitis