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ER 3 > Cholecystitis > Flashcards

Cholecystitis Flashcards

1
Q

Emphysematous cholecystitis TXT

A

ABX w/ urgent cholescystectomy (alt Per-Q cholescystectomy)

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2
Q

Emphysematous cholecystitis is ass/w what POP?

A

DM/Old

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3
Q

Chronic cholecystitis important finding is?

A

Fibrotic GB wall thickening - recurrent obstructs

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4
Q

ICU admit for?

A

Acute cholecystitis and Cholangitis

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5
Q

Cholangitis is?

A

An ascending infectionof the biliary tree

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6
Q

Normal CBD diameter is?

A

<5mm (+1 per decade or hx of cholecystectomy)

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7
Q

How can you visualize microlithiasis?

A

CT or U/S

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8
Q

Biliary sludge AKA

A

Microlithiasis

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9
Q

Acute cholecystitis labs?

A

Increased WBC/CRP

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10
Q

DX SOC for acute cholecystitis is?

A

U/S (differing all biliary tree etiologies and pancreatitis due to stones)

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11
Q

Acute cholecystitis features?

A 
Localized RUQ pain w/ peritoneal irritation (increases severity)
Rigidity/ Rebound TTP
Murphy Sign
\+- fever
Jaundice (obstruct)
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12
Q

Pain relief w/ opioids for cholecystitis is ass/w?

A

Spasms of Sphincter of Oddi and Increased biliary pressure

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13
Q

Biliary colic can develop into?

A

Acute cholecystitis or

acute calculous cholescysistis

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14
Q

Acute Aclaculous cholecystitis is?

A

No stones (LC) but ML to have comps
Ass/w Major conditions/situations (burns, Septic shock)
RF- DM- X-IMM

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15
Q

Charcots/Reynolds triad/pentad is for?

A

Acute cholecystitis

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16
Q

Microlithiasis is composed of

A

cholesterol crystals
Calcium bilirubinate pigament
Calcium Salts

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17
Q

Biliary colic is ass/w?

A

Food intake or circadian rhythm (peaks at midnight)

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18
Q

Post-Cholecystectomy syndrome is?

A

MisDx + recent cholecystectomy = persistent ABD S/S or Leak

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19
Q

Admitting for cholangitis also reqs?

A

ER consult for ERCP

20
Q

Acalculous cholecystitis is ass/w

A

inpt critically ill, X-imm, Fulminant and gangrene/perf
High M/M
CT w/ IV contrast - cholescintigraphy

21
Q

Gallstone ileus is?

A

Mechanical SBO due to ectopic G.stone in intestinal lumen via biliary-enteric fistula

22
Q

Cholecocholithiasis is? classes?

A

Stones in CBD ( or stricture/tumor)
Primary - Develops in CBD
2dy - Migrates into CBD from GB

23
Q

DX criteria for acute cholecystitis?

A 
Local signs (Murphy sign and RUQ pain/mass/TTP)
SYS signs (Fever, ^CRP, ^ WBC)
Imaging - consistent
24
Q

ABNL LFTs is suggestive of?

A

CBD obstruction (GGT esp for Choledocholithiasis)

25
Q

Elective cholescystectomy is reserved for?

A

High risk pts (SCA, Planned organ transplant, GB Cancer risk due to ethnicity)

26
Q

Riglers traid?

A

SBO
Pneumonia
Ectopic G.Stone

27
Q

ABX PRN for acute cholecystitis?

A

Cephs,
Carbapenems
B-lactams
or Metronidazile + flouroquinolone

28
Q

Murphy sign is

A

Cessation of deep inspiration due to pain w/ GB palpation

29
Q

TOC for biliary colic?

A

S/S control and

Outpt Laproscopic cholecystectomy

30
Q

Asymptomatic cholecystitis w/stones TXT?

31
Q

Gas producing cholecystitis is due to? and called?

A

Emphysematous cholecystitis
Gas producing organisms
(E.Coli, Kleb, Clostridium spp.)

32
Q

Acute cholecystitis worse case pathophys?

A

Evolves to necrosis and gangrene GB wall perf

Gangeronous cholecystitis

33
Q

Mirizzi syndrome is

A

Impact compression of cystic duct or GB causing jaundice (extrinsic CBD compression)

34
Q

Rx symptomatic control for biliary colic?

A 
1st NSAIDs ( then opioids)
Anti-emetics
35
Q

Gallstone ileus is best Dx w/ what SOC?

A

CT (then XR)

36
Q

SOC for choledocholithiasis?

A

MRCP/ERCP (Stones + dilation = indirect evidence)

37
Q

ABD U/S findings for acute cholecystitis?

A

Sonographic murphy sign
GB wall >3mm
Pericholecystic fluid
Sens for stones

38
Q

GB stones MC causes?

A

biliary colic

39
Q

Emphysematous cholecystitis imaging SOC?

A

CT w/ contrast (seen w/ XR and U/S)

40
Q

SOC for acute cholecystitis?

41
Q

Acute cholecystitis jaundice causes?

A 
Choledocholithiasis
Impact compression (Cystic Duct or Gall bladder) 
--- AKA mirizzi syndrome
42
Q

Biliary colic features? (few hrs)

A

Pain (epigastric/RUQ) radiating Back
N/V
NO peritoneal signs/fever

43
Q

Suspected Dx of acute cholecystitis?

A

One local and One sys sign = suspected

44
Q

Charcots triad is? Reynolds pentad?

A

Fever
Jaundice (2/3)
RUQ pain
ADD - AMS and Shock = Reynolds

45
Q

Common cause of Post-Cholecystectomy syndrome is?

A

choledocholithiasis

46
Q

Definitive Dx of acute cholecystitis?

A

One local and one sys sign + image finding

47
Q

Riglers triad is?

A

Common S/S of Gallstone ileus

ER 3 (6 decks)

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