Cholecystitis, Cholangitis

Question 1

Cholecystitis Risk Factors

Answer 1

Age
Female
Pregnancy
Obesity
Rapid wt loss
elevated triglycerides
meds (HRT, BC)

Question 2

Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines
Need 1 from each:
Local s/sx?
Systemic Signs?
Imaging Findings?

Answer 2

Murphy’s sign
Pain or tenderness in RUQ
RUQ mass

Fever
Leukocytosis
Elevated CRP

A confirmatory finding on US or hepatobiliary scintigraphy

Question 3

Grade III (severe) acute cholecystitis:
CV dysfunction:
Neurological dysfunction:
Respiratory dysfunction:
Renal dysfunction:
Hepatic dysfunction:
Hematological dysfunction:

Answer 3

hypotension requiring treatment with dopamin >/= 5 ug/kg/min or any dose of NE
Decreased LOC
PF ratio < 300
oliguria, Cr > 2.0 mg/dL
PT-INR > 1.5
plt count < 100,000

Question 4

Grade II (moderate) acute cholecystitis:
WBC count:
Palpable tender mass where?
Duration of complaints > how long?
Marked local inflammation such as?

Answer 4

elevated > 18,000
RUQ
72hr
gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)

Question 5

Grade I (mild) acute cholecystitis

Answer 5

Does not meet criteria of Grade Ii or III acute cholecystitis

Question 6

Cholecystitis Management

Answer 6

NPO/NGT
IVFs
Abx
Surgery

Question 7

Cholecystitis Surgery
Treatment of choice in most?
Treatment for those with moderate disease?
Treatment for severe cases or when failed conservative tx?

Answer 7

early laparotomy (upon presentation)
early or delayed (2-3 mo)
percutaneous drainage

Question 8

Cholecystitis Complications

Answer 8

GB perf
peritonitis
fistula
hepatic abscess
pancreatitis

Question 9

Acute Acalculous Cholecystitis Etiology

Answer 9

Fasting
TPN
Sepsis
Major Trauma
Major Nonbiliary surgery
childbirth
multiple blood transfusions
MV
Opiates

Question 10

Acute Acalculous Cholecystitis Clinical Manifestations?

Answer 10

Fever
RUQ pain (Murphy’s Sign)
Leukocytosis
Elevated liver enzymes, bili, alk phos

Question 11

Acute Acalculous Cholecystitis Diagnosis

Answer 11

RUQ US
distended GB, thickened wall, pericholecystic fluid without gallstones, sludge may be present

Question 12

Management of Acute Acalculous Cholecystitis

Answer 12

NPO/NGT
IVFs
Abx
Surgery

Question 13

Cholangitis Etiology

Answer 13

acute inflammation of common bile duct usually d/t cholelithiasis
cancer
post-op obstruction following intervention
strictures
PSC
Organisms & increased biliary pressure
decreased bile flow resulting in stasis & bacterial proliferation

Question 14

Cholangitis Clinical Manifestations

Answer 14

Charcot’s Triad (fever, RUQ pain, jaundice)
MS changes
hypotension

Question 15

Cholangitis Diagnosis

Answer 15

leukocytosis
elevated bil, alk phos, mildly elevated LFTs
US
CT scan
ERCP

Question 16

Cholangitis Management

Answer 16

Supportive (fluids, pain control)
removal of obstruction & infection, usually with ERCP
abx

Question 17

Grade I (mild) cholangitis

Answer 17

responds to initial medical treatment, with clinical findings improved

Question 18

Grade II (Moderate) cholangitis

Answer 18

unaccompanied by organ dysfunction, but does not respond to initial medical treatment; clinical manifestations &/or lab data not improved

Question 19

Grade III (severe) cholangitis

Answer 19

accompanied by >/= 1 new-onset organ dysfunction