Acute Cholecystitis Flashcards
1
Q
How do gallstones form?
A
Increased cholesterol in bile
or
Increased calcium bilirubinate in bile
- form microscopic and macroscopic crystals
- microscopic = trapped in gallbladder mucus = sludge
- macroscopic = blocks ducts = symptoms
2
Q
Cholesterol Gallstones cause
A
- liver secreted cholesterol and phospholipids into bile
- bile salts dissolve them in gall bladder
- cholesterol stones if increased secretion from liver or increases stasis of bile salts in gallbladder
3
Q
Calcium/Bilirubin/Pigment Gallstones cause
A
- unconjugated bilirubin + calcium = insoluble precipitate
- increased haem turnover increases bilirubin = crystals
- bacteria can hydrolyse conjugated bilirubin = increases calcium bilirubinate crystals
4
Q
When are pigment gallstones seen often?
A
Haemolytic anaemia and cirrhosis
5
Q
Main RF of gall stones
A
4 F’s
- fat
- forty
- fair
- female
6
Q
Other RF of gallstones
A
- CMV/salmonella/cryptosporidium
- obesity
- diabetes
- increased cholesterol
- decreased fibre
- > 60
- cirrhosis
- statins
- total parenteral nutrition
7
Q
Imaging for cholecystitis
A
US
- gallstone see
- thickened gallbladder wall
- distended gallbladder
8
Q
Sign of perforation on US
A
pericholecystic fluid
9
Q
Define cholecystitis
A
Inflammation of the gallbladder
- mostly calculous
- cystic duct blocker by gallstone or biliary sludge
10
Q
Symptoms of cholecystitis
A
RUQ pain Sharp and constant Radiates to right shoulder fevers N&V Murphy's sign
11
Q
Ix
A
High WCC
High CRP
High ALT/ALP
U&E’s, clotting, ABG
12
Q
Tx
A
ABs
IV fluids
Analgesia
Cholecystectomy within 1 week
13
Q
Complications
A
- chronic = repeated, mild long lasting symptoms
- gallbladder empyema
- fistula
- Mirizzi syndrome
14
Q
Types of fistulae which can form
A
- cholecystoduodenal
- cholecystojejunal
- cholesystocolonic
