Gallbladder

Question 1

40 year old obese woman presents with RUQ pain, heartburn, nausea, diarrhea, fever, and bloating. Pain is aggravated by fatty food. Referred pain to the right shoulder, scapula, and mid-back. Dx?

Answer 1

Gallbladder disease

Question 2

Positive murphy’s sign might indicate…

Answer 2

gallbladder tenderness from infection, like acute cholecystitis, cholelithiasis

Question 3

Labs ordered for RUQ pain

Answer 3

CBC, LFT, lipase

Question 4

Diagnostic tests for RUQ pain

Answer 4

US, HIDA, EGD, CT (EGD and CT used to r/o other causes of RUQ pain)

Question 5

Cholelithiasis

Answer 5

gallstones

Question 6

cholecystitis

Answer 6

inflammation/infection of gallbladder

Question 7

biliary dyskinesia

Answer 7

dysfunction of the gallbladder

Question 8

choledocholithiasis

Answer 8

gallstones in the bile ducts

Question 9

most common organisms in acute cholecystitis

Answer 9

klebsiella, e.coli, and strep

Question 10

Biliary colic aka…

Answer 10

chronic cholecystitis

Question 11

types of stones in cholelithasis

Answer 11

75% are cholesterol stones, 25% are pigment stones

Question 12

tx of symptomatic cholelithiasis or acute cholecystitis

Answer 12

laparoscopic cholecystectomy

Question 13

acute vs. chronic cholecystitis leukocytosis

Answer 13

chronic usually does not have elevated WBC’s, acute does

Question 14

Most common complication of acute cholecystitis

Answer 14

pericholecystic abscess

Question 15

acute cholecystitis tx and alternatives

Answer 15

usually laparoscopic cholecystectomy just like in symptomatic cholilithiasis. If poor candidate of surgery, do drainage via cholecystostomy tube. Or put patient on IV antibiotics (means of delaying surgery)

Question 16

Biliary dyskinesia test results

Answer 16

US negative, HIDA shows decreased ejection fraction

Question 17

Tx of biliary dyskinesia

Answer 17

avoid food triggers, bentyl, levbid, laparoscopic cholecystectomy

Question 18

10% of patients that get laporoscopic cholecystectomy done in biliary dyskinesia will not improve- what to do?

Answer 18

Make sure EGD is done in this population

Question 19

Acute cholecystitis not involving stones is…

Answer 19

acalculous cholecystitis

Question 20

emphysematous cholecystitsi

Answer 20

acute cholecystitis caused by a gas producing anaerobe (clostridia)

Question 21

Gallbladder hydrops

Answer 21

gallbladder obstructed by a stone and filled with clear liquid

Question 22

Patient presents with RUQ pain, jaundice, F/C, dark urine, pruritis. Elevated liver enzymes, gallstone pancreatitis. Diagnosis?

Answer 22

choledocholithiasis

Question 23

Tests done for choledocholithiasis

Answer 23

MRCP, PTC, ERCP, and IOC

Question 24

Prior to using ERCP, what must resolve?

Answer 24

Pancreatitis

Question 25

What procedures should be avoided in patient with cholangitis?

Answer 25

Cholangiogram (imaging of bile ducts by Xrays) such as PTC or ERCP

Question 26

Types of cholangitis

Answer 26

Bacterial/suppurative cholangitis, sclerosing cholangitis, recurrent pyogenic cholangitis

Question 27

Causes of bacterial cholangitis

Answer 27

Bacterial infection of the bile ducts caused by stone, neoplasm, stricture

Question 28

Charcot’s triad

Answer 28

Fever/chills, RUQ pain, jaundice- in bacterial cholangitis

Question 29

Patient presents with RUQ pain, jaundice, fever, and chills. Elevated WBC, elevated bilirubin and alkaline phosphate. LIkely diagnosis?

Answer 29

Bacterial cholangitis

Question 30

Patient presents with RUQ pain, jaundice, fever, and chills. Elevated WBC, elevated bilirubin and alkaline phosphate. Patient also in shock and in confusion. Likely diagnosis?

Answer 30

Suppurative cholangitis

Question 31

Tx of bacterial cholangitis

Answer 31

IV antibiotics. if that doesn’t work, decompress the bile duct with PTC, surgery, or endoscopic sphincterotomy

Question 32

ERCP shows stenosis and “beading” of bile ducts. Patient has mild pruritis, jaundice and UC. You suspect…

Answer 32

Sclerosing cholangitis

Question 33

Sclerosing cholangitis

Answer 33

Nonbacterial inflammatory narrowing of hte bile ducts

Question 34

What role does E. coli have in recurrent pyogenic cholangitis?

Answer 34

E. coli initiates pigment stone formation in the bile ducts

Question 35

What is gallbladder carcinoma associated with in 70% of cases?

Answer 35

Gallstones

Question 36

What cancer involves the ducts of the liver?

Answer 36

cholangiocarcinoma

Question 37

Patient presents with mass in RUQ and tenderness. Persistent RUQ pain, jaundice, worse with fatty food. Dx?

Answer 37

gallbladder carcinoma