Case 3- gallstones Flashcards
He’s a doctor! That means we can rule out? But seriously this pp is 52 slides so I’m gonna pick and choose shit.
Drug/alcohol abuse. Clearly he must be a saint. –NOT.
Abdominal pain- features to look for
Everything we ask SPs. Location, description, when it started, does it radiate, anything that makes it worse/better, any other associated sx.
What weird things can present as abdominal pain?
pneumonia, MI. Ask about alcohol use.
Bowel sounds
1. high pitched?
- obstruction
Abdominal exam
inspect, auscultate, rectal, pelvic, testicular, vitals signs. Oh, and push where it hurts- just make sure you do it last.
Cholethiasis vs cholecystitis vs choledocholitthiasis vs ascending cholangitis
Cholelithiasis= stone from high cholesterol or low bile acid
Acute cholecystitis- obstruction of cystic duct
Choledocholithiasis- calculi in common bile duct
Ascending cholangitis= inflammation of common bile duct
Prevalence of stones?
You probably don’t have gallstones because you’re ____.
Non hispanic black.
Female native americans have lots.
Risk factors for gall stones
Old, female (from estrogen), fat, eat lots of cholesterol, preggers, anorexic (fast weight loss), Crohns, high TAGs.
5 F’s
Fair, fat forty, fertile female.
Acute right upper quadrant pain?
- short episode, not jaundice, no fever= biliary colic
- fever, persistent pain= cholcystitis
- fever, bilirubin high- consider choledocolithiasis or ascending cholangitis (common bile duct issue)
- fever, high lipase-pancreatitis
Pertinent negatives from his pee
not dark, no bilirubin, no ALT/AST stuff. Fever= infection, rigors (shaking)= bacteremia
Tests for biliary colic show?
normal everything.
Cholecystitis test shows?
high WBC, normal everything else
Cholangitis test
High everything, but ALP, GGT, direct bilirubin is higher than in pancreatitis
Gallbladder pancreatitis?
high everything, but lipas and amylase are crazy high.
Choledocholithiasis
Lipase and amylase normal, everything else is high.
