Cholelithiasis and Cholecystitis Flashcards
Risk for gallstones?
- increases with age
- more females than males
- clusters in family (dietary)
- obesity
- multiparity
components of most gallstones?
-75% are mixed stones (cholesterol, bile salts and lecithin)
Single large stones are usually made out of?
cholesterol
BLACK Pigmented stones - most common cause? usually made out of?
- hemolytic anemia
- calcium bilirubinate
BROWN pigmented stones - most common cause:
-usually made out of?
-associated with infected bile and CBD stones (acute cholelisthiasis)
calcium bilirubinate
What is gallbladder sludge?
composed of mucoprotein, cholesterol crystals and calcium bilirubinate== precursor to stones
Which type of cholecystitis has a positive culture for bacteria?
Acute almost 50% of the time
Chronic about half of that
Most common organisms to invade biliary system?
Most common: -E Coli -Klebsiella (aerobes) anything from GI system
Chronic cholecystitis - symptoms:
- biliary colic - from obstruction
- RUQ pain with radiation to back or scapula
- nausea/Vomit
- pain resolves 1-5 hrs
- if pain >24hrs=acute cholecystitis
chronic cholecystitis
- physical exam/symptoms
- pain may be absent between episodes of biliary colic
- NO PALPABLE MASS
- mild pain on deep RUQ
acute cholecystitis - physical exam/symptoms
- persistent pain
- nausea and vomit common
- low grade fever - common
- pain RUQ
positive murpheys sign with which cholecysttiis?
Acute
Which cholecystitis patient LOOKS sick?
ACUTE
Acute cholecystitis - PE?
- uncomfortable patient in constant pain
- Murpheys sign +
- tender mass may be palpable
- IF NON-TENDER = malignant
- fever,chlls, shaking, jaundice
Lab studies - cholecystitis
- CBC
- electrolytes
- liver function
- amylase/llipase to rule out pancreatitis
Test of choice for suspected cholecystitis?
-Ultra sound
HIDA Scan-
- radionucleide scanning - that binds to bile
- for hospital - critically ill patients
what to do with people who have asymptomatic stones?
just leave alone
Chronic cholecystitis - symptoms?
- biliary colic is classic
- abd exam is usually benign between bouts of colic
- FEVER AND CHILLS ARE NOT PRESENT
- LABS ARE NORMAL
Choledocholithiasis means?
stones in the common ducts
cholangitis means?
infection in the common bile duct due to stones
Charcot’s triad symptoms are?
jaundice
RUQ pain
fever with chills
Reynolds pentad symptoms are?
jaundice
RUQ pain
fever with chills
(CHARCOT + additional below)…
+hypotension
+mental confusion
seen with cholangitis
Mirizzis syndrome is?
large stone impaced in cystic duct obstructs common bile duct
