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Big Surgery > Acute Cholecystitis > Flashcards

Acute Cholecystitis Flashcards

1
Q

What is charcot’s triad?

A
  1. juandice
  2. increased white cell count
  3. fever
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2
Q

What is the age that this peaks?

A

-40-50 years

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3
Q

What is acute cholecystitis?

A

-inflammation of the gallbladder caused by cholelithiasis

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4
Q

What is the pathophysiology of cholecystitis?

A
  • gallstones obstructing the cystic duct which leads to inflammation and distension of the gallbladder
  • bacterial infection can occur(E. coli, klebsiella, enterobacter)
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5
Q

What are the clinical signs?

A
  1. RUQ pain that can radiate to the right shoulder and back
  2. usually after meals
  3. positive Murphy’s sign-when you push on the right upper quadrant and ask patient to inspire that causes immense pain and the patients stops inspiring
  4. guarding
  5. nausea and vomiting
  6. fever, malaise
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6
Q

What tests can we do diagnose acute cholecystitis?

A
  1. CRP and elevated white cell count(inflammatory markers)
  2. mild elevations in ALT,AST and amylase are possible
  3. If GGT, ALP, and bilirubin means that there is biliary obstruction and not cystic duct obstruction
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7
Q

What imaging can we do acute cholecystitis?

A
  1. We do a transabdominal ultrasound:
    - gallbaldder wall thickening by 4mm
    - gallbladder double wall sign
    - sometimes there’s free fluid surrounding the gallbladder
    - presence of gallstones
    - sonographic Murphy’s sign
  2. HIDA scan-99mTc radioactive tracer is injected and usually we would not able to see the gallbladder if there is an obstruction there. We have wait 30-60 minutes
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8
Q

Are MRCP and abdominal ultrasounds usually done?

A

-No

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9
Q

What is the treatment for acute cholecystitis?

A
  1. supportive
    - Nil per mouth
    - analgesia
    - antiemetics
    - broad spectrum AB
    - FLUIDS and electrolytes
  2. cholecystectomy as soon as possible
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10
Q

What antibiotics would you use in this patient?

A
  1. mild/moderate community acquired: cefazolin, ceftriaxone and metronidazole
  2. severe community acquired: ciprofloxacin plus metronidazole
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11
Q

What are the two types of acute cholecystitis?

A
  1. calculous acute cholecystitis(90%)

2. acalculous cholecystitis(5-10%)

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12
Q

What are the symptoms of acalculous cholecystitis?

A
  1. RUQ pain

2. Fever

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13
Q

What is the pathophysiology of acalculous cholecystitis?

A
  • already occurs in patients that are already ill: sepsis, multi-organ failure, severe trauma, prolonged trauma, prolonged periods of total parenteral feeding
  • this causes biliary stasis
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14
Q

How do you diagnose acalculous cholecystitis?

A

-transabdominal ultrasound that will show a thickened gallbladder wall with no gallbladder stones

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15
Q

How do we treat acalculous choilecystitis?

A

-AB

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16
Q

What is the preferred treatment for acalculous cholestitis?

A

-cholestotomy to drain the fluid from the gallbladder

17
Q

What are the complications of acute cholestitis?

A
  • chronic cholecystitis
  • perforation
  • gallbladder empyema
18
Q

What are the complications of chronic cholesistitis?

A
  1. gallbladder carcinoma

2. porcelain gallbladder-fibrotic and calcified gallbladder

19
Q

What are the complications of laparoscopic cholestectomy?

A

-bleeding
-leaking bile
due to iatrogenic mistakes and clipping of the bile ducts or the hepatic artery
-subhepatic abscess
-postcholestectomy syndrome

20
Q

What is post-cholesectomy syndrome?

A
  • happens to 10-15% of patients
  • happens after gallbladder removal
  • persistent abdominal pain, dyspepsia, diarrhea due to sphincter of oddi dysfunction
21
Q

What are the 4 ways the cholecystitis can present and the signs and symptoms:

A
  1. Resolved-syptoms resolve because the stone is deimpacted
  2. Gallbladder empyema-There is low grade fever, right upper discomfort and palpable gallbladder
  3. Gallbladder mucocele- patient feels well, slight discomfort in the upper abdomen
  4. Perforation in the peritoneum-
    - contained- toxically ill patient with swinging temperature and RUQ pain
    - peritonitis: can dislodge and cause small bowel obstruction
22
Q

What is choledocholithiasis?

A

Stones in the bile duct causing obstructive jaundice
-This presents with epigastric pain and jaundice that presents for 2-5 days unless it passes
The presence of stones and jaundice often leads to cholangitis

23
Q

What are the 4 risks of doing an ERCP?

A
  1. acute pancreatitis
  2. bleeding
  3. cholangitis
  4. perforation of the duodenum

Big Surgery (21 decks)

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