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What are some conditions that would be included in the differential diagnosis in acute cholecystitis?

Acute appendicitis
Renal stones
Heart attack
GERD and hiatal hernia


What are the different types of stones found in cholelithiasis? How will etiology influence treatment?

-Cholesterol stones (75% of gallstones, cholesterol and calcium bilirubinate, slow process of formation- over years)
-Pigment stones (20% of galsstones, calcium bilirubinate or calcified bilirubin, black stones more common than brown stones in US, assoc. w hemolytic anemia or cirrhosis)


What are the best methods of imaging for cholelithiasis, in terms of safety, cost, and reliability?

US- method of choice for initial investigation in acute, not as useful for common bile duct stones
Cholescintigraphy/HIDA- more useful for chronic
Endoscopic retrograde cholangiopancreatography (ERCP)- gold standard for detection common bile duct stones (risk of rupture)


what are the grave signs in GB obstructive disease?

Cullen sign- superficial edema and bruising SubQ tissue around the umbilicus (acute pancreatitis)
Turner sign- bruising of the flanks, appearing as a blue discoloration (acute pancreatitis)
Charcot's triad- RUQ pain, jaundice, and fever (send to ER)


Which hydrotherapies are best for cholelithiasis, biliary dyskinesia, and 
(know how they differ, any precautions, or potential 

acute GB- chaparral infused castor oil (Yarnell), no heat, 30 min TID
chronic GB- alternating hot vinegar and cold packs
biliary dyskinesia- castor oil packs


what is the imaging of choice for cholelithiasis in ER?

helical abdominal CT (incr radiation exposure)


What dietary/lifestyle changes are appropriate for cholelithiasis and biliary 

-avoidance of saturated fat and high glycemic index foods
-veggies, fruits, foods high in omega-3 and incr water soluble fiber (except legumes) are protective against gallstone formation
-food allergy/intolerance avoidance
-elimination/challenge diet
-tobacco cessation
-liver cleansing foods (beets, radishes, burdock root)
high water soluble foods (flax seed, guar gum, oat brain)
-avoid of SAD, animal protein (esp pork and eggs), and arachidonic acid rich foods


what is the role of food allergies, and which ones are commonly seen in 
cholelithiasis, biliary dyskinesia, and cholecystitis?

- pork and eggs (most commonly)
-onion, fowl, milk, coffee, orange, corn, beans and nuts


What are the primary etiologies for cholelithiasis? 

-tobacco, sedentary, SAD diet


Why isn’t lithotripsy used more often as a therapy? 

-a treatment that involves breaking up the stones which then get passed by the body
-create sharp pieces that can puncture tissue


what is the role of exercise (or lack thereof) in gallbladder conditions?

Exercise is an essential aspect of lifestyle change.
-Exercising 30 minutes 5x/week eliminated 34% of cases of symptomatic gallstones
-Obvious benefit in reducing obesity
-Exercise also helps reduce cholesterol levels in the biliary tract


What are the appropriate herbal therapies for cholelithiasis, biliary dyskinesia, 
and cholecystitis? How do they differ?

-Rowachol (volatile oil mixture)- menthol, pinene, menthone, borneal, camphene, and 1,8 cineol (eucalyptol) in an olive oil base
-enteric-coated peppermint oil
-Fumaria off. - balancing effect on GB (stimulating in stasis, calming in colic)
-Dioscorea villosa (wild yam)- strong spasmolytic (acute GB)
-Ammi visnaga (khella)- powerful spasmolytic (acute GB)
-Atropa belladonna (belladonna)- very powerful spasmolytic (acute biliary colic)
-Additional spasmolytics: Lobelia inflata, Piscidia piscipula, Corydalis yanhusious, Hyoscyamus niger, Gelsemium sempervirens


What is in the acute cholecystitis tincture (yarnell)?

echinacea angustifolia
dioscorea villosa
ammi visnaga
ceanothus greggii
baptisia tinctoria
fumaria off.
zingiber off.