Hepatic/biliary/spleen Flashcards
(34 cards)
What percentage of the population has gallstones? Of these what percentage has acute cholecystitis?
10-15%
-of these that are symptomatic 20% develop acute cholecystitis
Gallbladder wall thickness above what indicates inflammation?
> 3mm
What imaging modality has the highest sensitivity and specificity for diagnosing acute cholecystitis? The second?
-HIDA scan
-US and MRCP are tied
What are the benefits of early cholecystectomy for acute cholecystitis?
-lower risk of major bile duct injury
-shorter hospital stay
-decreased risk of recurrent gallstone symptoms within 3 months
If a cholecystectomy for acute cholecystitis needs to be delayed how long should it be delayed?
45-60 days after onset of symptoms
What are the most common bacteria found associated with acute cholecystitis?
-E. coli
-Klebsiella
-Enterobacter
What are the top 3 antibiotics in terms of biliary penetration?
-Zosyn (pip-tazo)
-tigecycline
-Augmentin (amox-clavulanate) and ciprofloxacin
What percentage of patients with cholelithiasis have associated common bile duct stones? With acute cholecystitis?
-10-20%
-5-15%
What is the negative predicitive value that a patient with normal LFTs and acute cholecystitis will have CBD stones? The positive predictive value of abnormal LFTS?
-97%
-15%
What is the specificity of serum bilirubin for common bile duct stones in acute cholecystitis?
-if cutoff value is 1.7 it’s 60%
-if cutoff value is 4 it’s 75%
What predictive factors place an acute cholecystitis patient at moderate risk for associated CBD stones?
-abnormal LFTs other than bilirubin
-age > 55
-clinical gallstone pancreatitis
What predictive factors place an acute cholecystitis patient at strong risk for associated CBD stones?
-CBD diameter > 6mm (prior to cholecystectomy)
-bilirubin 1.8-4
What predictive factors place an acute cholecystitis patient at very strong risk for associated CBD stones?
-can see stone on RUQ US
-clinical ascending cholangitis
-bilirubin >4
What are risk factors to an increased postop morbidity and mortality for a cholecystectomy?
-age > 80
-Mannheim peritonitis index >/= 29
-significant comorbidities
What factors indicate an increased risk of mortality in patients with gangrenous cholecystitis?
-increased age
-low WBC
What postop morbidities are associated with DM?
-cardiovascular events
-renal failure
-infections
What percent of patients with cholangitis have all of Charcot’s triad?
50-70%
(fever, pain, jaundice)
What are the most common symptoms of cholangitis in the elderly?
-hypotension
-confusion
Per the Tokyo guidelines what qualifies as moderate (grade II) cholangitis?
-WBC >12k or <4k
-fever > 39
-age >75
-total bilirubin >5
-hypoalbuminemia
Per the Tokyo guidelines what qualifies as severe (grade III) cholangitis?
-cardiovascular dysfunction requiring dopamine
-LOC
-respiratory distress
-oliguria or creatinine >2
-INR > 1.5
-PLT < 100k
What is the cellular origin of biliary cystadenoma?
thought to be ectopic clusters of embryonic bile ducts
Which hepatic lobe is biliary cystadenoma more commonly found int?
left
What percent of biliary cystadenoma has malignant transformation? Into which cancer?
-20%
-biliary cystadenocarcinoma
What is the treatment for autoimmune hemolytic anemia?
-typically steroids
-splenectomy reserved for adult pts w/ steroid resistant disease
