Cholecystitis Flashcards
Emphysematous cholecystitis TXT
ABX w/ urgent cholescystectomy (alt Per-Q cholescystectomy)
Emphysematous cholecystitis is ass/w what POP?
DM/Old
Chronic cholecystitis important finding is?
Fibrotic GB wall thickening - recurrent obstructs
ICU admit for?
Acute cholecystitis and Cholangitis
Cholangitis is?
An ascending infectionof the biliary tree
Normal CBD diameter is?
<5mm (+1 per decade or hx of cholecystectomy)
How can you visualize microlithiasis?
CT or U/S
Biliary sludge AKA
Microlithiasis
Acute cholecystitis labs?
Increased WBC/CRP
DX SOC for acute cholecystitis is?
U/S (differing all biliary tree etiologies and pancreatitis due to stones)
Acute cholecystitis features?
Localized RUQ pain w/ peritoneal irritation (increases severity) Rigidity/ Rebound TTP Murphy Sign \+- fever Jaundice (obstruct)
Pain relief w/ opioids for cholecystitis is ass/w?
Spasms of Sphincter of Oddi and Increased biliary pressure
Biliary colic can develop into?
Acute cholecystitis or
acute calculous cholescysistis
Acute Aclaculous cholecystitis is?
No stones (LC) but ML to have comps
Ass/w Major conditions/situations (burns, Septic shock)
RF- DM- X-IMM
Charcots/Reynolds triad/pentad is for?
Acute cholecystitis
Microlithiasis is composed of
cholesterol crystals
Calcium bilirubinate pigament
Calcium Salts
Biliary colic is ass/w?
Food intake or circadian rhythm (peaks at midnight)
Post-Cholecystectomy syndrome is?
MisDx + recent cholecystectomy = persistent ABD S/S or Leak
Admitting for cholangitis also reqs?
ER consult for ERCP
Acalculous cholecystitis is ass/w
inpt critically ill, X-imm, Fulminant and gangrene/perf
High M/M
CT w/ IV contrast - cholescintigraphy
Gallstone ileus is?
Mechanical SBO due to ectopic G.stone in intestinal lumen via biliary-enteric fistula
Cholecocholithiasis is? classes?
Stones in CBD ( or stricture/tumor)
Primary - Develops in CBD
2dy - Migrates into CBD from GB
DX criteria for acute cholecystitis?
Local signs (Murphy sign and RUQ pain/mass/TTP) SYS signs (Fever, ^CRP, ^ WBC) Imaging - consistent
ABNL LFTs is suggestive of?
CBD obstruction (GGT esp for Choledocholithiasis)
Elective cholescystectomy is reserved for?
High risk pts (SCA, Planned organ transplant, GB Cancer risk due to ethnicity)
Riglers traid?
SBO
Pneumonia
Ectopic G.Stone
ABX PRN for acute cholecystitis?
Cephs,
Carbapenems
B-lactams
or Metronidazile + flouroquinolone
Murphy sign is
Cessation of deep inspiration due to pain w/ GB palpation
TOC for biliary colic?
S/S control and
Outpt Laproscopic cholecystectomy
Asymptomatic cholecystitis w/stones TXT?
Observe
Gas producing cholecystitis is due to? and called?
Emphysematous cholecystitis
Gas producing organisms
(E.Coli, Kleb, Clostridium spp.)
Acute cholecystitis worse case pathophys?
Evolves to necrosis and gangrene GB wall perf
Gangeronous cholecystitis
Mirizzi syndrome is
Impact compression of cystic duct or GB causing jaundice (extrinsic CBD compression)
Rx symptomatic control for biliary colic?
1st NSAIDs ( then opioids) Anti-emetics
Gallstone ileus is best Dx w/ what SOC?
CT (then XR)
SOC for choledocholithiasis?
MRCP/ERCP (Stones + dilation = indirect evidence)
ABD U/S findings for acute cholecystitis?
Sonographic murphy sign
GB wall >3mm
Pericholecystic fluid
Sens for stones
GB stones MC causes?
biliary colic
Emphysematous cholecystitis imaging SOC?
CT w/ contrast (seen w/ XR and U/S)
SOC for acute cholecystitis?
ABD U/S
Acute cholecystitis jaundice causes?
Choledocholithiasis Impact compression (Cystic Duct or Gall bladder) --- AKA mirizzi syndrome
Biliary colic features? (few hrs)
Pain (epigastric/RUQ) radiating Back
N/V
NO peritoneal signs/fever
Suspected Dx of acute cholecystitis?
One local and One sys sign = suspected
Charcots triad is? Reynolds pentad?
Fever
Jaundice (2/3)
RUQ pain
ADD - AMS and Shock = Reynolds
Common cause of Post-Cholecystectomy syndrome is?
choledocholithiasis
Definitive Dx of acute cholecystitis?
One local and one sys sign + image finding
Riglers triad is?
Common S/S of Gallstone ileus