Gallbladder Flashcards
Anatomy of the GB
RUQ of abd under liver
Cystic duct exits and joins common hepatic duct to form common bile duct
CBD empties into the duodenum at ampulla of Vader, which is surrounded by the sphincter of Oddi
What stimulates bile rls from the GB
CCK (cholecystokinin) causes the GB to contract, which rls’s bile into the duod.
Why isn’t there bile reflux back into the GB?
spiral valves of Heister
Arterial supply to the GB
cystic artery, which usu comes from the R hepatic artery
What is the triangle of calot?
cystic duct
common hepatic duct
cystic artery (some say edge of liver and the cystic artery goes through the triangle)
What is cholelithiasis
Gallstones
What is biliary colic
Pain produced when the GB contracts against a stone in the neck of the GB or as a stone passes through the bile duct
What is acute cholecystitis
inflammation and infection of the GB
usu w total or partial obstruction of the cystic duct
What are the most common organisms cultured during an episode of acute cholecystis?
E. coli Klebsiella enterococci Bacteroidies fragilis Pseudomonas
What is cholodocholithiasis
Stone in the CBD
What are stones made of?
Cholesterol (80%)
Calcium carbonate
or both
How do stones form?
Bile becomes supersaturated with cholesterol, stones precipitate out of soln.
High cholesterol diet can be a cause of cholesterol stones.
Calcium bilirubinate stones are found in a/w which diseases?
chronic biliary infection
cirrhosis
hemolytic processes- sickle cell anemia, thalassemia, spherocytosis
T/F Spinal cord injury predisposes to pigment stones (calcium bilirubinate)
False- predisposes to cholesterol stones
Px of gallstones
most pts are asx
Px of biliary colic
RUQ or epigastric pain, often radiates to right side or back
Usu postprandial, precipitated by fatty food intake
Lasts several hours before resolving
Also nausea/vom with it
But NO fever
Px of cholecystitis
Constant pain w progressive worsening. Fever chills sweats. It’s inflam/infection, so it’s signs of that- signs of peritoneal irritation, including RUQ rebound and guarding.
Murphy’s sign- arrest of inspiration on deep palpation of RUQ
Px of choledocholithiasis
Dark urine or light colored stools- since the CBD is blocked, bile pigments can’t get to the GI tract- so it’s not cleared in stool, and instead it’s cleared renally.
Also a/w jaundice and signs of biliary colic
Ascending cholangitis px
RUQ pain plus fever and chills. It’s infection of bile duct from ascending bacteria.
Gallstone pancreatitis px
epigastric tenderness/pain radiating to the back
pancreatitis is dt choledocholithiasis- stone in the CBD
WHat is the Charcot triad?
For cholangitis
- Fever
- RUQ pain
- Jaundice
What is the Reynolds pentad
For cholangitis that progressed to sepsis- charcot plus hypotension and mental status chgs
(charcot - fever, RUQ, jaundice)
Dx eval for cholecystitis
increased WBC
US- fluid around GB, thickened GB wall, GB distention
if it’s acalculus cholecystitis, use HIDA (cholescintigraphy)- inject radioactive nucelotide into liver, it’s excreted into biliary tree- if it’s acute cholecystitis, then the cystic duct is obstructed so the GB will not fill- all radionucelotide will go out to the duodenum
Dx eval for cholodocholithiasis
Increased serum bilirubin and alk phos
US- detects stones
Best for CBD stones is ERCP- use endoscope to visualize ampulla, put contrast in retrograde. Can also extract stones.
MRCP good for detecting CBD stones but not therapeutic like ERCP
