Gallstone Diseases

Question 1

What is the most common type of gallstone made of?

Answer 1

Cholesterol

Question 2

What is the most common color of gallstones?

Answer 2

Green - cholesterol

Question 3

Who is at risk for gallstones made of cholesterol?

Answer 3

Female
Fat
Forty
Fertile

Question 4

What is a lesser common type of gallstone made of?

Answer 4

Bilirubin

Question 5

What is the color of a less common type of gallstone?

Answer 5

Black - bilirubin

Question 6

What causes someone to have gallstones made of bilirubin?

Answer 6

Hemolysis
– Can occur in kids

Question 7

Choledocholithiasis

Answer 7

Stone stuck in the common bile duct or pancreatic duct

Question 8

How will the gallbladder look with choledocholithiasis?

Answer 8

Mostly unaffected but will possibly have stones within it

Question 9

How will the common bile duct look with choledocholithiasis?

Answer 9

It will be dilated proximal to the stone

Question 10

What is a sign a stone is stuck somewhere in the common bile duct/pancreatic duct that will not be present if the stone was stuck elsewhere?

Answer 10

JAUNDICE

Question 11

What lab changes will be present with Choledocholithiasis?

Answer 11

HIGH Alk Phos and Bilirubin
+/- HIGH LFTs

Question 12

What is the first diagnostic test for RUQ pain?

Answer 12

RUQ Ultrasound

Question 13

Following an ultrasound, what is the order of things that should be done for Choledocholithiasis and related disorders? (3)

Answer 13

• MRCP
• ERCP
• Cholecystectomy

Question 14

What is Ascending Cholangitis?

Answer 14

Choledocholithiasis + INFECTION of the biliary tree

Question 15

Stone stuck in the common bile duct + infection of the biliary tree

Answer 15

Ascending Cholangitis

Question 16

What is the Triad of symptoms that can present with Ascending Cholangitis?

Answer 16

RUQ pain
Fever
Jaundice

Question 17

What is the Pentad of symptoms that can present with Ascending Cholangitis?

Answer 17

RUQ pain
Fever
Jaundice
Altered mental status
Hypotension

Question 18

If you suspect Ascending Cholangitis, what diagnostics/treatment should you do?

Answer 18

SKIP the MRCP
–> ERCP, Cholecystectomy, ABx

Question 19

What is Gallstone Pancreatitis?

Answer 19

Choledocholithiasis with stone stuck in the pancreatic duct + PANCREATITIS

Question 20

What lab change will point you toward Gallstone Pancreatitis?

Answer 20

HIGH Lipase 3X upper limit of normal

Question 21

For Gallstone Pancreatitis and Choledocholithiasis, what is the order of diagnostic tests/treatment that should be done?

Answer 21

1. RUQ US
2. MCRP
3. ERCP
4. Cholecystectomy

Question 22

For Choledocholithiasis, Gallstone Pancreatitis and Ascending Cholangitis, what lab changes are commonly present?

Answer 22

HIGH Alk phos and Bilirubin
+/- HIGH LFTs/Lipase

Question 23

Where is the stone stuck with Acute Calculous Cholecystitis?

Answer 23

Cystic Duct

Question 24

Is the common bile duct affected with Acute Cholecystitis?

Answer 24

NO – just the gallbladder

Question 25

Will jaundice be present with Acute Cholecystitis?

Answer 25

NO

Question 26

Following a (-) RUQ US, what diagnostic test should be done for Acute Calculous Cholecystitis?

Answer 26

HIDA scan

Question 27

What classifies a (+) HIDA scan?

Answer 27

Inability for tracer to enter the gallbladder

Question 28

What 3 things will be seen on RUQ Ultrasound with Acute Calculous Cholecystitis?

Answer 28

1. Gallstones 2. Pericholecystic fluid 3. Gallbadder wall thickening

Question 29

In what patients does Acute Acalculous Cholecystitis occur?

Answer 29

Critically ill - receiving parental nutrition

Question 30

What will be seen on RUQ ultrasound with Acute Acalculous cholecystitis?

Answer 30

1. Pericholecystic fluid 2. Gallbladder wall thickening

Question 31

What is the treatment for Acute Calculous Cholecystitis? Acalcuous?

Answer 31

Calculous = Cholecystectomy + ABx Acalcuous = Percutaneous Drain

Question 32

What is Biliary Colic?

Answer 32

Symptomatic Cholelithiasis

Question 33

Cholelithiasis

Answer 33

Gallstones in the gallbladder

Question 34

What type of symptoms will be present with Biliary Colic?

Answer 34

RUQ pain that is worse after eating and fatty foods -- episodic

Question 35

What will be seen on RUQ ultrasound with Biliary Colic?

Answer 35

Gallstones ONLY

Question 36

How does a Gallstone Ileus arise?

Answer 36

Gallstone passes through a biliary-enteric fistula

Question 37

Where often is the obstruction with a Gallstone Ileus?

Answer 37

Gallstone lodges in the Ileum

Question 38

Signs of a Gallstone Ileus?

Answer 38

BOWEL OBSTRUCTION = Abdominal distention, N/V, constipation and pain

Question 39

What will a CT scan show with Gallstone Ileus?

Answer 39

AIR in the BILIARY TREE -- dilated bowel/obstructing stone too

Question 40

What will a CT scan show with Gallstone Ileus?

Answer 40

AIR in the BILIARY TREE -- dilated bowel/obstructing stone too

Question 41

Common choice of antibiotic treatment for Acute Cholecystitis?

Answer 41

Piperacillin-Tazobactam