Cholelithiasis and Cholecystitis

Question 1

What is unique about the GB relation ot the surface/skin?

Answer 1

Gets bigger as it gets closer to the skin!

Question 2

Where is bile concentratd?

Answer 2

In the gallbladder! Superconcentrated solutions are more likely to precipitate.

Question 3

Where is CCK produced?

Answer 3

In the Duodenum

Question 4

What is the effect of CCK on the gallbladder?

Answer 4

Contraction and release of Bile.

Question 5

What are the actions of CCK?

Answer 5

Induced satiety. 
inhibts hypothalmic hunger sensation
Prevents grehlin action
Beta cell proliferation
Reduced inflammation by parasites and Bacteria

Question 6

Where does GB pain refer?

Answer 6

low bac and right shoulder

Question 7

Stone formation risk factors

Answer 7

Age
Female
Native american
Obesity
Multiparity
Rapid wt loss
Hemolytic disease
Alcohol
Meds: cholesterol 
Post Partum
TPN
High estrogen

Question 8

Waht is the disease mechanism of stones?

Answer 8

need a nidus for growth
Food => CCK production
GB wall contraction => stone impaction.

Question 9

What happens if a stone sticks to the wall?

Answer 9

Symptomatic Cholecystitis

Question 10

What happens if stone advances?

Answer 10

Obstruction (CBD), pancreas

Question 11

What are signs and symptoms of Stones?

Answer 11

Pain in RUQ or referral pts
Time of day, after eating
Murphy’s sign of diaphragmatic splinting
Fever/Chills(inf.)

Question 12

What are the clinical types of GB disease?

Answer 12

Acute Cholecystitis
Chronic Cholecystitis
Ascending Cholangitis

Question 13

What are the sonographic types of GB disease?

Answer 13

Calculous
Acalculous
Sono Murphy’s sign

Question 14

What is the general treatment for GB disease.

Answer 14

Pain Control(opiates nauseating), Hydration, NPO, Pt septic or unrelenting: admit
Mimic or uncertain:admit

Question 15

What is the primary imaging modality for GB disease?

Answer 15

Ultrasound

Question 16

What is the worst size of Stones?

Answer 16

2-3 mm. Can impact into the common bile duct. (pancreatitis)

Question 17

What is a HIDA Scan?

Answer 17

A nuclear med functional study. technetium labeled acedic acid. Exc. into GB in 30 min. Inject CCK to see if it will empty
Abn: Non-filling/non-emptying/symptoms with CCK

Question 18

Non-filling meaning?

Answer 18

Obstructed

Question 19

Non-emptying meaning?

Answer 19

Non-functional

Question 20

Waht is the surgical therapy for GB disease?

Answer 20

Cholecystectomy. Elective Laparoscopic

ERCP can remove stone.

Question 21

What mimics GB disease?

Answer 21

Acute Inferior wall myocardial infarction, RLL pneumonia, subdiapregmatic abscess, appendicitis, hepatitis, pancreatitis.

Question 22

Waht are complications for GB disease?

Answer 22

Gallstone Ileus(erodes throught the wall), Bowel obstruction with large stone

Question 23

Post operative considerations?

Answer 23

Re-check to make sure bile duct is clear.

Question 24

S&S of Acute Cholecystitis?

Answer 24

Unrelenting pain, fever, RUQ Tender, Nausea and Vomiting

Question 25

S&S of Chronic Cholecystitis?

Answer 25

Intermittent, often after a fatty meal. well between bouts

Question 26

S&S of Ascending Cholangitis

Answer 26

Exquisite RUQ Pain, Peritoneal signs

Signs of Sepsis.

Question 27

S&S of Calculous?

Answer 27

US image + for shadowing object
-single, multiple or sludge
May show free, impacted or distal stone

Question 28

S&S of Acalculous?

Answer 28

US negative for shadowing object

Thickened GB wall, fluid in GB fossa

Question 29

What is the Sonographic Murphy’s sign

Answer 29

Symptoms reproduced by pressure on probe @ GB.