Cholelithiasis and Cholecystitis Flashcards
What is unique about the GB relation ot the surface/skin?
Gets bigger as it gets closer to the skin!
Where is bile concentratd?
In the gallbladder! Superconcentrated solutions are more likely to precipitate.
Where is CCK produced?
In the Duodenum
What is the effect of CCK on the gallbladder?
Contraction and release of Bile.
What are the actions of CCK?
Induced satiety. inhibts hypothalmic hunger sensation Prevents grehlin action Beta cell proliferation Reduced inflammation by parasites and Bacteria
Where does GB pain refer?
low bac and right shoulder
Stone formation risk factors
Age Female Native american Obesity Multiparity Rapid wt loss Hemolytic disease Alcohol Meds: cholesterol Post Partum TPN High estrogen
Waht is the disease mechanism of stones?
need a nidus for growth
Food => CCK production
GB wall contraction => stone impaction.
What happens if a stone sticks to the wall?
Symptomatic Cholecystitis
What happens if stone advances?
Obstruction (CBD), pancreas
What are signs and symptoms of Stones?
Pain in RUQ or referral pts
Time of day, after eating
Murphy’s sign of diaphragmatic splinting
Fever/Chills(inf.)
What are the clinical types of GB disease?
Acute Cholecystitis
Chronic Cholecystitis
Ascending Cholangitis
What are the sonographic types of GB disease?
Calculous
Acalculous
Sono Murphy’s sign
What is the general treatment for GB disease.
Pain Control(opiates nauseating), Hydration, NPO, Pt septic or unrelenting: admit Mimic or uncertain:admit
What is the primary imaging modality for GB disease?
Ultrasound
What is the worst size of Stones?
2-3 mm. Can impact into the common bile duct. (pancreatitis)
What is a HIDA Scan?
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
Non-filling meaning?
Obstructed
Non-emptying meaning?
Non-functional
Waht is the surgical therapy for GB disease?
Cholecystectomy. Elective Laparoscopic
ERCP can remove stone.
What mimics GB disease?
Acute Inferior wall myocardial infarction, RLL pneumonia, subdiapregmatic abscess, appendicitis, hepatitis, pancreatitis.
Waht are complications for GB disease?
Gallstone Ileus(erodes throught the wall), Bowel obstruction with large stone
Post operative considerations?
Re-check to make sure bile duct is clear.
S&S of Acute Cholecystitis?
Unrelenting pain, fever, RUQ Tender, Nausea and Vomiting
