Acute Cholecystitis Flashcards
What is thought to be the cause of acute acalculus cholecystitis
Caused by obstruction of the cystic duct by biliary sludge
What is the risk of asymptomatic stones becoming symptomatic per year?
1-2% per year
How do you elicit a Murphy’s sign?
Inspiratory arrist secondary to pain when the examiner performs deep palpation in the right subcostal area.
Which patient population should cholecystostomy tubes be considered?
Confirmed acute cholecystitis in critically ill, significantly hemodynamically unstable patients
How long should cholecystostomy tubes be left in place prior to cholecystectomy?
3 months
What are the most common biliary tract bacteria?
Escherichia coli, Klebsiella pneumonae, Enterococcus, and Enterobacter species
What is the critical view of safety in laparoscopic cholecystectomy?
The cystic duct and cystic artery will be revealed as the only two structures entering the gallbladder
What options exist if CBD stones are identified during lap chole?
laparoscopic CBD exploration or choledochoscopy (3mm scope)
What percentage of patient shave variations in biliary anatomy?
15-20%
When concerned for a post-operative bile leak after cholecystectomy, which tests would you order to confirm biloma?
Abdominal Ultrasound, HIDA (or ERCP)
What operation should be performed if a common bile duct injury occurs?
Roux-en-Y hepaticojejunostomy
T/F In patients with severe cirrhosis, significant bleeding can be limited by performing a partial cholecystectomy, in which the posterior portion of the gallbladder wall is left intact on the gallbladder fossa.
TRUE
What is the treatement for acute cholecystitis in pregnant patients based on trimester?
First-IV abx/conservative; Second-lap chole; Third-IV abx/conservative
