Cholecystitis

Question 0

TCM Diagnosis

Answer 0

Hypochondriac pain

Always misdiagnosed as gastritis

Question 1

Definition

Answer 1

Inflammation of gallbladder in the right hypochondriac region causing severe colicky pain

• duodenum alkaline and stomach is acidic so if GB reverse flows into stomach this creates an imbalance
• abnormal metabolism of cholesterol
• blockage of cystic duct
• very common in China, more in women than men, in overweight people
• electrolytes not balanced
• later stage of cancer patients

Question 2

Shoulder pain differentiation

Answer 2

Shoulder pain on right = Cholecystitis

Shoulder pain on left = Heart attack

Question 3

Acute vs Chronic Differentiation

Answer 3

Acute:

Repeat attacks( previous GB attack history) 
Severe pain in right hypochondrium 
Radiating pain in right shoulder
Fever, chills, aversion to cold
Nausea/vomiting 

Chronic:
Belching/gas
Poor digestion signs
Dull burning pain 
Worse after greasy meal

Question 4

Murphy’s sign:

Answer 4

Palpate right abdomen with left hand, patients legs bent, get patient to deep breath ~

Negative test: on exhale GB and liver descend and there’s no pain

Positive test: on exhale and if GB inflamed on the push of the hand you can feel the GB, patient will begin severe pain and will stop breathing

Question 5

POT

Answer 5

Soothe liver
Regulate qi
Remove damp heat

Question 6

Pattern differentiation

Answer 6

Liver qi stagnation creating GB and liver fire

Damp heat

Question 7

Points

Answer 7

Le 6 (Dannanxue) - GB
Sp 6
UB 18/19
Du 9 - Jaundice 
Liv 2 - qi stagnation 
St 36 - Damp heat
Sp 9 - damp heat
Du 4, LI 11, LI 4 - fever
Liv 13, Liv 14, GB 34 - colicky pain ( knife pain)
Pc 6, UB 17 - chest tightness 
Ren 12

Question 8

Tests/diagnosis

Answer 8

WCB count
Ultrasound
Le 6 sensitive

Question 9

Treatment

Answer 9

Points
Electro acupuncture- longer time if during an attack
Auricular acupuncture- sp/st, Lrg intestine and small intestine, revtum, liver, GB, sub cortex, endocrine, pancreas, sympathetic
Diet- with ear-seeds in eat oily foods like pigs feet soup, the gelation will help expel the gallstones

Question 10

Patient education

Answer 10

Same as hypochondriac pain

Eat liquid food not solid food

Nauseas/vomiting: might need IV to get enough fluids