Cholecystitis

Question 1

What is the official term for the neck of the gall bladder where stones often lodge?

Answer 1

Hartmann’s pouch

Question 2

What is the main difference in presentation between biliary colic (gall bladder squeezing on stones) and cholecystitis

Answer 2

Biliary colic pain lasts <2hrs

Cholecystitis pain lasts throughout the day + fever + vomiting

Question 3

Where does cholecystitis pain radiate to?

Answer 3

Back and right scapula

Question 4

What is the main difference in presentation between colic and peritonism?

Answer 4

Peritonism patients want to stay rigid

colic patients can’t get comfortable, keep moving

Question 5

What is murphy’s sign?

And how do you know a pt is showing true murphy’s?

Answer 5

2 fingers over gall bladder, ask pt to breath in = pain and breath catch.

Murphy’s only +ve if this sign is -ve on the left

Question 6

What is phlegmon?

Answer 6

Mass of adherent omentum and bowel that may be palpable. SIgn of cholecystitis

Question 7

What is Boas’ sign?

Answer 7

Hyperaesthesia below the right scapula. Sign of cholecystitis

Question 8

In cholecystitis, what would you expect to find on a urine dip?

Answer 8

Raised bilirubin

Raised urobilinogen

Question 9

Over what size would you consider bile ducts to be dilated on ultrasound?

Answer 9

> 6mm

Question 10

Gall bladder wall oedema on ultrasound suggests?

Answer 10

Inflammation

Question 11

If dilated ducts seen on US, what investigation is required?

Answer 11

MRCP (magnetic resonance cholangiopancreatoraphy)

Question 12

What is the antibiotic therapy for cholecystitis

Answer 12

cef and met

Question 13

What percentage of episodes of acute cholecystitis settle after over 24-48hrs with conservative therapy?

Answer 13

80-90%

Question 14

What are the conservative therapies for acute cholecystitis (4)

Answer 14

NBM
Fluid resus
Analgesia
Abx

Question 15

What are the signs of a gall bladder empyema (2) and how would you manage it?

Answer 15

High fever
RUQ mass

Percutaneous drainage: cholecystectomy

Question 16

Which hormone stimulates gall bladder contractions

Answer 16

CCK

Question 17

What is the phrase used to describe the appearance of gallstones on an AXR?

Answer 17

Porcelain gallbladder

Question 18

What is the name of a gall bladder blocked by a stone and swollen with secretions?

Answer 18

Mucocele

Question 19

How would you differentiate between a presentation of cholecystitis and ascending cholangitis?

Answer 19

Ascending cholangitis causes high grade fever 39< and rigors

Question 20

What is the colloquial name of ascending cholangitis

Answer 20

The silent assassin

Question 21

What are the features of charcot’s triad, and what does it describe?

Answer 21

Fever, jaundice, RUQ pain

Ascending cholangitis

Question 22

What conditions (3) make a person more likely to have gallstone ileus?

Answer 22

Dementia
Learning difficulties
Paralysis

Caused by chronic cholecystitis that hasn’t been treated, fistula forms between gall bladder and duodenum for gallstone to pass through and block ileo-cecal valve