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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
Elective cholescystectomy is reserved for?
High risk pts (SCA, Planned organ transplant, GB Cancer risk due to ethnicity)
26
Riglers traid?
SBO Pneumonia Ectopic G.Stone
27
ABX PRN for acute cholecystitis?
Cephs, Carbapenems B-lactams or Metronidazile + flouroquinolone
28
Murphy sign is
Cessation of deep inspiration due to pain w/ GB palpation
29
TOC for biliary colic?
S/S control and | Outpt Laproscopic cholecystectomy
30
Asymptomatic cholecystitis w/stones TXT?
Observe
31
Gas producing cholecystitis is due to? and called?
Emphysematous cholecystitis Gas producing organisms (E.Coli, Kleb, Clostridium spp.)
32
Acute cholecystitis worse case pathophys?
Evolves to necrosis and gangrene GB wall perf | Gangeronous cholecystitis
33
Mirizzi syndrome is
Impact compression of cystic duct or GB causing jaundice (extrinsic CBD compression)
34
Rx symptomatic control for biliary colic?
``` 1st NSAIDs ( then opioids) Anti-emetics ```
35
Gallstone ileus is best Dx w/ what SOC?
CT (then XR)
36
SOC for choledocholithiasis?
MRCP/ERCP (Stones + dilation = indirect evidence)
37
ABD U/S findings for acute cholecystitis?
Sonographic murphy sign GB wall >3mm Pericholecystic fluid Sens for stones
38
GB stones MC causes?
biliary colic
39
Emphysematous cholecystitis imaging SOC?
CT w/ contrast (seen w/ XR and U/S)
40
SOC for acute cholecystitis?
ABD U/S
41
Acute cholecystitis jaundice causes?
``` Choledocholithiasis Impact compression (Cystic Duct or Gall bladder) --- AKA mirizzi syndrome ```
42
Biliary colic features? (few hrs)
Pain (epigastric/RUQ) radiating Back N/V NO peritoneal signs/fever
43
Suspected Dx of acute cholecystitis?
One local and One sys sign = suspected
44
Charcots triad is? Reynolds pentad?
Fever Jaundice (2/3) RUQ pain ADD - AMS and Shock = Reynolds
45
Common cause of Post-Cholecystectomy syndrome is?
choledocholithiasis
46
Definitive Dx of acute cholecystitis?
One local and one sys sign + image finding
47
Riglers triad is?
Common S/S of Gallstone ileus

ER 3 (6 decks)

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