gallbladder disease

Question 1

what is cholelithiasis?

Answer 1

stones in the gallbladder

Question 2

what is choledocolithiaisis?

Answer 2

stones in the common bile duct

Question 3

what is it called when cholelithiasis becomes symptomatic?

Answer 3

gallbladder disease

Question 4

what is cholecystitis?

Answer 4

infection of obstructed gallbladder

Question 5

what is cholangitis?

Answer 5

infection of obstructed bile duct

Question 6

what are the symptoms of cholelithiasis?

Answer 6

billiard cholic

• lasting under an hour
• constant
• radiating to back and shoulder
• nausea vomiiting and sweating

Question 7

why do you get biliary cholic with cholelithiasis?

Answer 7

bc when the gallbladder contracts against gallstones it compresses the cystic duct

Question 8

how can cholelithiasis be diagnosed?

Answer 8

• USS of right upper quadrant
• stones cast an acoustic shadow below the gallbladder
• they move freely when the individual turns-> distinguishes them form carcinoma

Question 9

what are the risk factors for developing gallbladder cancer?

Answer 9

• gallstones >3cm
• calcified gallbladder
• gallbladder adenomas

Question 10

what is treatment of gallbladder disease?

Answer 10

medical:
symptom control with;
- spasmolytic= butylscopalamine 
opioids= buponorphine
treat with;
ursodeoxycholic acid-> esp for those who are not  eligible for surgery

ESWL- breaks stone down with shock waves
surgical:
- cholecystectomy

Question 11

how does ursodeoxycholic acid work?

Answer 11

• decreases cholesterol absorption
• so stops new gallstones from forming
• dissolves existing gallstones

Question 12

who is suitable for ESWL?

Answer 12

- less than 3 gallstones between 4-30mm
contraindicated in...
- pregnancy 
- cholecystitis 
- choledocolithiasis 
- pancreatitis 
- coagulopathies

Question 13

what can be seen on examination of individuals with choledocolithiasis?

Answer 13

courvoisier’s sign-palpable gallbladder, since the obstructed common bile duct will cause the gallbladder to dilate

Question 14

what are some associated issues you can have with choledocolithiasis?

Answer 14

associated pancreatitis:
- increase in amylase and lipase levels

associated hepatitis:
- ALT and AST are elevated

Question 15

what are blood results like in choledocolithiasis?

Answer 15

• leukocytosis
• increased total bilirubin
• increase alanine phophotase
• increase glutamyl transferase

Question 16

how can you diagnose choledocolithiasis?

Answer 16

• RUQ USS- dilated common bile duct and intrahepatic duct

- MRCP- magnetic resonance cholangiopancreatography

Question 17

what is the treatment of choledocolithiasis?

Answer 17

• IV fluids to treat dehydration

- ERCP= endoscopic retrograde cholangiopancreatography- to remove stones

Question 18

what is acalculus cholecystitis?

Answer 18

acute cholecystitis that is not caused by by gallstones

- often caused due to bile stasis

Question 19

why can chronic cholecystitis cause porcelain gallbladder?

Answer 19

• because of continuous cycle of blockage and dislodging of gallstones there is intermittent injury to gall bladder walls and this causes them to calcify

this can lead to increased risk of gallbladder cancer r

Question 20

what are clinical signs of acute cholecystitis?

Answer 20

murphy’s sign

- press down and ask px to breathe in- pain gets worse

Question 21

how to diagnose acute cholecystitis?

Answer 21

USS- distended gallbladder, thickening of wall, fluid around

HIDA scan- radioactive tracer will show that gallbladder isn’t filling due to obstruction

Question 22

what is treatment of acute cholecystitis?

Answer 22

NSAIDS- analgesic
IV fluid
antibiotics

gold standard= cholesectomy

cholecystectomy- if can’t have surgery- this allows gallbladder to drain out

Question 23

what are clinical signs of cholangitis?

Answer 23

charcots triad

• RUQ pain
• jaundice
• fever

reynolds pentad (septic patients)

• hypotension
• altered mental status
• along with charcot’s triad

Question 24

treatment of acute cholangitis

Answer 24

• fluids
• antibiotics
• ERCP
• cholecystectomy after gallstones have been removed