Cholecystitis/cholelithiasis, Pancreatitis, Peritonitis Flashcards
what makes up calots triangle and when is this of clinical importance
- Medial-common hepatic duct
- Inferior-cystic duct
- Superior-inferior surface of the liver
- cinically important when completing a cholecystectomy to allow safe ligation of the cystic duct and artery
apex of triangle is pointed at liver
what are the most common type of gallstones
cholesterol gallstones
what are the 3 things that can cause gallstones
- high cholesterol
- high bilirubin
- slow emptying gallbladder
what factors would put someone at increased risk for cholelithiasis
- being a woman (OCPs, pregnancy, hormone replacement, anything causing increased estrogen)
- pragnancy
- obestity (increased cholesterol)
- advanced age
- rapid weight loss
- certain medical illnesses (high LDL or TG, DM, liver disease, anemia)
what can protect against gallstones
- meditteranean diet
- caffienated coffee (???)
what is the pathophys behind symptomatic cholelithiasis
- stones blocking cystic duct/gallbladder outlet
- creates inflammation of gallbladder = pain
what are the s/s of biliary colic secondary to cholelithiasis
- RUQ pain radiating to R shoulder
- diaphoresis, nausea, vomiting
- pain at night/following meals
what is the diagnostic modality of choice for cholelithiasis
Abdominal US
can follow up with CT
what is the treatment of choice for cholelithiasis
laparoscopic cholecystectomy
give NSAIDs for pain
when do you treat cholelithiasis
only when symptomatic
What is an intraoperative cholangiogram?
An Xray of your bile ducts, usually done during a cholecystectomy.Viewing the bile ducts before removal of gallbladder helps ensure the surgeon does not accidentally cut or damage CBD.
what is the nonsurgical treatment for symptomatic cholelithiasis
Ursodeoxycholic acid (Ursodiol, Actigall)
for NONsurgical canditates
what is the MC cause of cholecystitis
gallstones (get lodged in cystic duct)
what is the presentation of cholecystitis
- ill appearing
- RUQ pain rad to shoulder
- fever, tachycardia, NV
- murphys sign
what laboratory findings will you see in cholecystitis
- leukocytosis w L shift
- high serum bilirubin
what is the first line diagnotic for cholecystitis and what would it show
- abdominal US
- shows stone lodged in cystic duct and wall thickening (>4-5mm)
If abdominal US is positive what diagnostic modality should be used to confirm diagnosis
HIDA scan
what is the treatment plan for cholecystitis
- admit for IV pip/taz OR cipro+metro
- lap chole w/i 24 hours.
Continuous or progression of RUQ abd pain, tenderness, muscle guarding, fever, leukocytosis after 24-48 hours
Gangrenous Gallbladder
calcification of the gallbladder wall suggests what diagnosis
porcelain gallbladder
what is choledocolithiasis
gallstone in COMMON bile duct
what are the symptoms of choledocolithiasis
- RUQ pain
- Jaundice (sometimes w/o other symptoms)
- N/V
- epigastic ternderness
what lab findings would you see in choledocolithiasis
- high AST/ALT
- high Alk phos
- high GGT
- hyperbilirubinemia
