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Gastrointestinal > Cholelithiasis and Cholecystitis > Flashcards

Cholelithiasis and Cholecystitis Flashcards

1
Q

What is the only structures that enlarges as it approaches the skin?

A

Gallbladder

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2
Q

What is the location of the gallbladder?

A

Right costal margin at the midclavicular line

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3
Q

GB concentrations are stored bile how?

A

Lecithin concentrates it to a supersaturated solution

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4
Q

What is the hormone that causes the gallbladder to squeeze?

A

CCK

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5
Q

Where is CCK made? What causes it to be secreted?

A

Duodenum

Fatty meals

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6
Q

What is the effect of CCK in the brain?

A

Induce satiety

Inhibits hunger sensation

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7
Q

CCK inhibits the action of what hormone?

A

Ghrelin

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8
Q

What is the effect of CCK on beta-cell proliferation?

A

Induces it

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9
Q

What is the cause of visceral referral pattern of cholecystitis?

A

Right should blader d/t phrenic nerve

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10
Q

Who usually gets gallstones?

A

Fair
Fat
Female
Fertile

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11
Q

Do statins induce stone formation?

A

No

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12
Q

What drugs induce stone formation?

A

Bile sequestrants

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13
Q

What percent of the population has gallstones?

A

10%

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14
Q

What is the composition of gallstones?

A

Cholesterol
Bile salts
Lecithin
Cabilirubinate

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15
Q

Black gallstones indicate what? Brown?

A 
Black = hemolytic disease
Brown = Infection
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16
Q

What causes choledocholithiasis?

A

GB wall contraction with obstruction of gallstone

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17
Q

Why is there only referred pain with early cholecystitis?

A

Not hitting peritoneum

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18
Q

What is the symptoms that aggravate cholecystitis?

A

Breathing in deeply

Eating

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19
Q

Fever and chills with usual RUQ pain = ?

A

Sepsis secondary to cholecystitis

20
Q

What fraction of pts with stones never have symptoms?

A

2/3

21
Q

What are the ssx of acute cholecystitis?

A

unrelenting, RUQ pain
Fever
n/v

22
Q

What are the ssx of chronic cholecystitis?

A

Intermittent, often after fatty meals

23
Q

What are the ssx of ascending cholangitis?

A

Exquisite RUQ pain, Peritoneal signs

Signs of sepsis

24
Q

What are the US findings of the gallbladder with cholelithiasis?

A

may show free, impacted, or distal stones

25
Q

What does it mean to be acalculus?

A

Cholecystitis but without a visible gallstone on US

26
Q

What is the sonographic Murphy’s sign?

A

Symptoms reproduce by pressure on probe

27
Q

What are the complications of gallstones?

A

Gallstone ileus

Gallstone pancreatitis

28
Q

What are the labs that are elevated with cholecystitis? (3)

A

Alk phos
Total bili
Lipase if pancreatitis

29
Q

What is the next scan to order if the US is negative for gallstones?

A

HIDA scan

30
Q

What is the general treatment of cholelithasis?

A

Pain control
NPO
IVF (LR)
abx if septic

31
Q

When should pts with gallbladder issues be admitted?

A

Septic

impacted stone

32
Q

What is a HIDA scan?

A

Nuclear med functional study, with injection of technetium into gallbladder, with CCK injected later to cause contraction

33
Q

What are the three abnormal findings of a HIDA scan?

A
  • Non-filling (obstructed)
  • Non-emptying (non-functional)
  • Symptoms with CCK
34
Q

What is Ursodiol?

A

Drug that decreases cholesterol absorption

35
Q

What is ESWL?

A

Shock waves into gallbladder to break up stones

36
Q

What is the surgical treatment for cholecystitis?

A

Laparoscopic cholecystectomy

37
Q

What is it a surgical emergency to remove a gallbladder?

A

Ascending cholangitis

38
Q

What is ERCP?

A

Endoscopic retrograde cholangio pancreatoscopy

39
Q

What are the emergent causes of cholecystitis?

A
  • Infectious causes (ascending cholangitis)
  • Gallstone pancreatitis
  • Extremes of age
40
Q

What is Charcot’s triad of cholangitis?

A

Jaundice
Fever
RUQ pain

41
Q

What type of bacteria usually causes cholangitis?

A

Gram negative

42
Q

How do surgeons ensure that there are no stones after the gallbladder is removed?

A

Intraoperative cholangiogram

43
Q

What are the medical treatments for cholecystitis?

A

Ursodiol
ESWL (shock waves)
Contact dissolution

44
Q

The common cystic duct is a union between which two ducts?

A

Common hepatic

Common bile

45
Q

What is the combination of cholesterol, bile salt, and lecithin that leads to cholesterol solution, rather than cholesterol stones?

A

Low cholesterol
High lecithin
High bile salts

Gastrointestinal (42 decks)

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