Cholelithiasis and Cholecystitis Flashcards
What is the only structures that enlarges as it approaches the skin?
Gallbladder
What is the location of the gallbladder?
Right costal margin at the midclavicular line
GB concentrations are stored bile how?
Lecithin concentrates it to a supersaturated solution
What is the hormone that causes the gallbladder to squeeze?
CCK
Where is CCK made? What causes it to be secreted?
Duodenum
Fatty meals
What is the effect of CCK in the brain?
Induce satiety
Inhibits hunger sensation
CCK inhibits the action of what hormone?
Ghrelin
What is the effect of CCK on beta-cell proliferation?
Induces it
What is the cause of visceral referral pattern of cholecystitis?
Right should blader d/t phrenic nerve
Who usually gets gallstones?
Fair
Fat
Female
Fertile
Do statins induce stone formation?
No
What drugs induce stone formation?
Bile sequestrants
What percent of the population has gallstones?
10%
What is the composition of gallstones?
Cholesterol
Bile salts
Lecithin
Cabilirubinate
Black gallstones indicate what? Brown?
Black = hemolytic disease Brown = Infection
What causes choledocholithiasis?
GB wall contraction with obstruction of gallstone
Why is there only referred pain with early cholecystitis?
Not hitting peritoneum
What is the symptoms that aggravate cholecystitis?
Breathing in deeply
Eating
Fever and chills with usual RUQ pain = ?
Sepsis secondary to cholecystitis
What fraction of pts with stones never have symptoms?
2/3
What are the ssx of acute cholecystitis?
unrelenting, RUQ pain
Fever
n/v
What are the ssx of chronic cholecystitis?
Intermittent, often after fatty meals
What are the ssx of ascending cholangitis?
Exquisite RUQ pain, Peritoneal signs
Signs of sepsis
What are the US findings of the gallbladder with cholelithiasis?
may show free, impacted, or distal stones
What does it mean to be acalculus?
Cholecystitis but without a visible gallstone on US
What is the sonographic Murphy’s sign?
Symptoms reproduce by pressure on probe
What are the complications of gallstones?
Gallstone ileus
Gallstone pancreatitis
What are the labs that are elevated with cholecystitis? (3)
Alk phos
Total bili
Lipase if pancreatitis
What is the next scan to order if the US is negative for gallstones?
HIDA scan
What is the general treatment of cholelithasis?
Pain control
NPO
IVF (LR)
abx if septic
When should pts with gallbladder issues be admitted?
Septic
impacted stone
What is a HIDA scan?
Nuclear med functional study, with injection of technetium into gallbladder, with CCK injected later to cause contraction
What are the three abnormal findings of a HIDA scan?
- Non-filling (obstructed)
- Non-emptying (non-functional)
- Symptoms with CCK
What is Ursodiol?
Drug that decreases cholesterol absorption
What is ESWL?
Shock waves into gallbladder to break up stones
What is the surgical treatment for cholecystitis?
Laparoscopic cholecystectomy
What is it a surgical emergency to remove a gallbladder?
Ascending cholangitis
What is ERCP?
Endoscopic retrograde cholangio pancreatoscopy
What are the emergent causes of cholecystitis?
- Infectious causes (ascending cholangitis)
- Gallstone pancreatitis
- Extremes of age
What is Charcot’s triad of cholangitis?
Jaundice
Fever
RUQ pain
What type of bacteria usually causes cholangitis?
Gram negative
How do surgeons ensure that there are no stones after the gallbladder is removed?
Intraoperative cholangiogram
What are the medical treatments for cholecystitis?
Ursodiol
ESWL (shock waves)
Contact dissolution
The common cystic duct is a union between which two ducts?
Common hepatic
Common bile
What is the combination of cholesterol, bile salt, and lecithin that leads to cholesterol solution, rather than cholesterol stones?
Low cholesterol
High lecithin
High bile salts
