Cholecystitis Flashcards
Cholecystitis is
inflammation of the gallbladder that is usually caused by an obstructing gallstone
is the most common complication of gallstone disease
Biliary colic
occurs when the inflamed gallbladder becomes infected with gas-producing organisms.
Emphysematous cholecystitis
Choledocholithiasis, gallstones within the common bile duct, may be either primary (arising from within the____________) or, more commonly, secondary (____________).
bile ducts
forming in the gallbladder and then migrating to the common bile duct
Chronic cholecystitis
is a state of prolonged gallbladder inflammation typically caused by recurrent episodes of cystic duct obstruction by gallstones
is microlithiasis composed of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts.
may be visualized on CT or US.
The clinical course is variable. It may resolve spontaneously or progress to cause complications including biliary colic, cholecystitis, cholangitis, or pancreatitis.
Biliary sludge
occurs in the absence of gallstones. It occurs much less commonly than calculous cholecystitis but is more likely to result in complications.
Acute acalculous cholecystitis
Biliary colic description
presents with pain in the epigastrium or right upper quadrant of the abdomen that occasionally radiates to the back
described as steady
accompanied by nausea and vomiting
association with food intake is variable
circadian periodicity, with a peak in symptom occurrence around midnight
typically last a few hours or less
Fatty food intolerance is not a reliable predictor of gallstone presence
Murphy’s sign
the sudden cessation of deep inspiration due to pain when examining fingers reach the inflamed gallbladder upon palpation of the right subcostal region
is 65% sensitive and 87% specific for acute cholecystitis
Jaundice in the setting of biliary tract stone disease implies
obstruction of the common bile duct from choledocholithiasis or
extrinsic compression of the bile duct by an impacted cystic duct or gallbladder stone or
adjacent inflammation (Mirizzi’s syndrome)
classic presentation of cholangitis is Charcot’s triad:
fever, right upper quadrant abdominal pain, and jaundice
Reynolds’ pentad adds_____________ and__________ to Charcot’s triad.
altered mental status
shock
Abnormal______________________ is the most sensitive and specific serum marker of choledocholithiasis
γ-glutamyl transpeptidase
is the imaging modality of choice for acute cholecystitis. ‘
Abdominal US
Normal common bile duct diameter is_______, although diameter is increased in patients with prior _______________
<5 mm
cholecystectomy and in the elderly
True or false
All opioids cause some degree of sphincter of Oddi spasm
True
ED management of biliary colic includes
symptom control and referral to a general surgeon for outpatient laparoscopic cholecystectomy. Symptom management includes antiemetics and analgesics. NSAIDs are first-line therapy.
Acute cholecystitis management
Acute cholecystitis and its complications are managed in the hospital with surgical consultation. Early laparoscopic cholecystectomy is often the treatment of choice. ED treatment includes the provision of anal- gesia, administration of antiemetics for nausea and vomiting, cessation of oral intake, volume and electrolyte replacement, and administration of antibiotics. Appropriate antibiotic regimens include second- and third-generation cephalosporins, carbapenems, β-lactam/β-lactamase inhibitor combinations, or the combination of metronidazole and a fluoroquinolone.
is the decompression procedure of choice in Cholangitis
Endoscopic retrograde cholangiopancreatography
is an alternative when endoscopic retrograde cholangiopancreatography is not feasible or is unsuccessful.
Percutaneous or surgical drainage
Disposition
Once symptoms are adequately controlled, patients with biliary colic are typically discharged from the ED to follow up with a general surgeon. They should be instructed to return to the ED if symptoms of gallstone complications (e.g., prolonged pain, fever, jaundice) arise. Patients who present to the ED with acute cholecystitis or cholangitis require hospital admission. For suspected cholangitis, emergency consultation or transfer to an institution with treatment capabilities for endoscopic retrograde cholangiopancreatography is necessary. Patients with severe illness, including many with cholangitis, should be admitted to a critical care unit.
Normal common
bile duct diameter is
<5 mm
high risk for gallstone complications
sickle cell disease,
patients with planned organ transplantation,
ethnic groups
at high risk for gallbladder cancer
Rigler’s triad
SBO - solid
pneumobilia - gas
ectopic gallstone - solid
