GI-Gallbladder Disease

Question 1

Cholelithiasis

Answer 1

Path: Cholesterol: Fat, female, fertile, forty and Native Americans;
- Pigmented: Hemolysis, African Americans

Pt: Colicky RUQ radiates to the shoulder, worse w fatty foods

Dx: RUQ U/S = Gallstones

Tx: Cholecystectomy (elective)
Ursodeoxycholic Acid (nonsurgical)

Question 2

Cholecystitis

Answer 2

Path: Gallstones in cystic ducts

1. Pericholecystic fluid
2. Thickened Wall
3. Gallstones

Pt: Constant RUQ Pain
+ Murphys sign
+ Inflammation (increase fever, increase WBC)

Dx: RUQ U/S = cholecystitis
HIDA scan if equivocal

Tx: NPO, IVF

• cholecystectomy (urgent)
• cholecystostomy (poor surgical)

Question 3

Choledocholithiasis

Answer 3

Path: Gall Stones in Common Bile Duct
WITH painful jaundice
with or without pancreatitis
with or without hepatitis

Pt: Constant RUQ pain AND jaundice
+ Murphys Sign
+ Inflammation ( increased fever, increased WBC)

Dx: RUQ U/S dilated CBD
MRCP if uncertain

Tx: NPO, IVF
ERCP urgently…or cholecystectomy with intraoperative cholangiogram

Question 4

Cholangitis

Answer 4

Path: Gallstone in CBD + infection - GNR, Anaerobes

Pt: Charcots triad

• RUQ Pain
• Jaundice
• Fever
• Hypotension

Reynold’s Pentad is above 3 with hypotension and AMS

Dx: RUQ U/S dilated biliary duct.

Tx: NPO, IVF + IV Abx (Cipro + Metronidazole)
ERCP emergently