B5.022 Prework 1 Cholecystitis/Cholelithiasis Flashcards
presentation of cholelithiasis
usually asymptomatic
may be discovered on imaging performed for reasons other than gallbladder disease
US findings with cholelithiasis
small stones
acoustic shadowing
presentation of acute cholecystitis
pain in RUQ
intermittent (early) or constant, severe (later)
association with greasy, fatty foods
diarrhea, nausea, emesis
major findings with acute cholecystitis
inflammation usually with overlying infection
fever
RUQ pain/tenderness
positive murphy’s sign
labs: increased WBCs, mildly elevated total bilirubin and transaminase
diagnosis of acute cholecystitis
RUQ ultrasound gallstones present thickened anterior wall >3mm pericholecystic fluid sludge
treatment of acute cholecystitis
admission, IV fluids, broad spectrum antibiotics, NPO
- resolution = elective cholecystectomy in 6 weeks
- continuation = urgent cholecystectomy
presentation of choledocholithiasis
pain in RUQ or epigastrium
intermittent pain at the beginning, constant or severe later
diarrhea, nausea, emesis
jaundice
major findings in choledocholithiasis
inflammation usually with overlying infection
fever
RUQ pain/tenderness
positive murphy’s sign
labs: increased WBCs, mildly elevated total bilirubin and transaminase
scleral icterus/jaundice
charcots triad
fever
RUQ pain
jaundice
diagnosis of choledocholithiasis
RUQ ultrasounds with visualization of common bile duct
gallstones present
CBD dilated >8mm
obstruction of biliary tract at the level of the common bile duct
treatment of choledocholithiasis
endoscopic retrograde cholangiopancreatography/ sphinceterotomy and retrieval of CBD stone
elective cholecystectomy may follow
presentation of acute ascending cholangitis
pain in RUQ or epigastrium pain intermittent or severe may present with diarrhea, nausea, or emesis jaundice altered mental status
major findings of acute ascending cholangitis
inflammation usually with overlying infection fever RUQ pain/tenderness positive murphy's sign labs: increased WBCs, mildly elevated total bilirubin and transaminase, elevated alk phos jaundice altered mental status hypotension sepsis
Reynolds pentad
fever RUQ pain jaundice altered mental status hypotension
treatment of acute ascending cholangitis
IV fluids and hemodynamic stabilization broad spectrum antibiotics urgent biliary drainage ERCP elective cholecystectomy
