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
what is the first line diagnostic for choledocolithiasis
what would it show
transabdominal US showing CBD dilation and impaired flow with stones.
what is the treatment of choice for choledocolithiasis
ERCP with sphincterotomy and stone extraction/stent replacement
What is cholangitis
inflammation of the common bile duct
what is the MCC of cholangitis
obstruction with e coli infection
what is the clinical presentation of acute cholangitis
charcots triad:
1. jaundice
2. RUQ pain
3. fever
reynolds pentad adds hypotension and AMS!
what laboratory results wil be positive in cholangitis
- leukocytosis
- ^CRP/ESR
- ^Alk phos and bilirubin
- AST/ALT
what is the diagnostic procedure of choice for acute cholangitis
ERCP
this is also the treatment obv
what is the MC complication of ERCP
pancreatitis
what additional treatment is used for acute cholangitis
- ERCP
- lap chole after
- IV ABX w pip/taz + metro OR cipro+metro
if you see beads on a string on MRCP what is the likely diagnosis
primary sclerosing cholangitis
what medication is used in patients undergoing rapid weight loss to prevent gallstone formation
ursodeoxycholic acid (bile salt)
what is the MC cause of pancreatitis
- gallstone MC
- heavy alcoholism next common
what is the clinical presentation of pancreatitis
- epigastric abdominal pain radiating to the back. improves w leaning forward
- NV
- fever, weakness, sweating
what diagnostics are used for pancreatitis diagnosis
serum amylase and lipase elevation.
what is the treatment for pancreatitis
- mild - NPO, NG tube, hydromorphone
- severe - admit to ICU and get surgical consult
what antibiotic is indicated in a patient with a pancreatitis abscess
imipenem
