cholelithiasis

Question 1

what is cholelithiasis and what are the common stones?

Answer 1

stones in the gallbladder not obstructing the bile duct.
most common stone is cholesterol. rest are bile salts and bile pigments

Question 2

risk factors for cholelithiasis?

Answer 2

female, forty, fat, fertile, hyperlipidemia, pregnancy, OCP use, rapid weight loss, fasting

Question 3

symptoms?

Answer 3

mostly asymptomatic unless it obstructs the bile duct -> biliary colic.

RUQ pain after eating fatty foods, radiates to epigastrium, LUQ, or the back. associated with N/V. this pain comes and goes. if it persists -> acute cholecystitis

Question 4

diagnosis and treatment?

Answer 4

incidental finding of abdomen US (acoustic shadows of the stones).

treatment not indicated unless:
-pt has porcelain gallbladder (calcified wall from excessive stones)
-pt has sickle cell anemia, pediatric, or immunocompromised
-stone is >2-3 cm

tx of choice is lap cholecystectomy

Question 5

acute cholecystitis and presentation?

Answer 5

inflammation of the gallbladder from obstruction of cystic duct by gallstone. secondary bacterial infections can be present

present with persistent biliary colic. N/V. fever. positive murphy sign

Question 6

diagnosis and treatment? acute cholecystitis

Answer 6

labs: leukocytosis and high CRP. mild elevations in AST,ALT, amylase, lipase (more than 3 times normal is pancreatitis).
cholestasis (high bilirubin, ALP, GGT) are UNCOMMON, if present consider biliary obstruction

abdomen ultrasound -> gallbladder wall thickening, pericholecystic fluid, acoustic shadows

can also do hida scan (non filling of gallbladder)

murphy sign: cessation of breathing (deep inspiration) upon palpating RUQ due to pain
tx: empiric antibiotics and lap cholecystectomy