Clinical Presentation of Cholecystitis (Acalculous, Acute and Chronic)

Question 1

What ethnicity gets GI disease more than any other?

Answer 1

Mexicans

Question 2

What are the 2 types of gall stones?

Answer 2

1. Cholesterol

2. Pigmented

Question 3

Who is most likely to get gall stones?

Answer 3

Fair, Forty year old, Female

Question 4

What is cholecystokinin (CCK)?

Answer 4

major hormone (produced in discrete endocrine cells that line the mucosa of the duodenum) responsible for gallbladder contraction and pancreatic enzyme secretion.

Question 5

What is biliary colic?

Answer 5

waxing and waning, poorly localized, postprandial UPPER ABDOMINAL PAIN radiating to the back with normal lab evaluations of liver function.

Question 6

What causes biliary colic?

Answer 6

CCK stimulated gallbladder contraction

Question 7

What bacteria is the most common cause of acute cholecystitis?

Answer 7

E. coli, followed by Klebsiella

Question 8

What is the general presentation of acute cholecystitis?

Answer 8

RUQ pain, +/- fever, +murphy’s sign, leukocytosis, nonspecfic elevation of liver enzymes

Question 9

Wha tis murphy’s sign?

Answer 9

inability to deeply to inspire when you push on the RUQ.

Question 10

What is acute acalculous cholecystitis?

Answer 10

cholecystitis without stones. It carries higher morbidity and mortality than acute calculous cholecystitis (with stones).

Question 11

What causes acute acalculous cholecystitis?

Answer 11

gallbladder stasis and ischemia

*classically long term ICU patients

Question 12

How do you diagnose acalculous cholecystitis?

Answer 12

gallbladder not visualized on HIDA scan or there is reduced ejection fraction

Question 13

What should you think if you see porcelain gallbladder?

Answer 13

gallbladder cancer

Question 14

What is choledocholithiasis?

Answer 14

stones in the bile ducts

Question 15

What is the biggest risk factor for cholangiocarcinoma?

Answer 15

sclerosing cholangitis

Question 16

What should you do to a patient with asymptomatic gallstones?

Answer 16

LEAVE THEM ALONE

Question 17

** A 42 y/o obese female presents with waxing and waning RUQ pain that radiates to the back that came on 2 hours after consuming a large, fatty meal. Liver enzymes are normal. Ultrasonography demonstrates stones in the neck of the gallbladder. The postprandial pain is most likely caused by what? (TEST QUESTION)

Answer 17

CCK stimulated gallbladder contraction

Question 18

** Charcot’s triad consists of which of the following? (TEST QUESTION)

Answer 18

RUQ pain, fever, jaundice

Question 19

** A 44 y/o female presents to the ER w/ RUQ pain, fever, and jaundice. Ultrasound shows gallstones, a thickened gallbladder wall, and a common bile duct size measuring 1.6 cm. There is a high probability of choledocolithiasis. Your next step to both diagnose and treat this patient would be what? (TEST QUESTION)

Answer 19

ERCP (Endoscopic retrograde cholangiopancreatography)

Question 20

** A 47 y/o female presents to the ER w/a fractured ankle. Upon full workup, studies reveal gallstones in her gallbladder. She has no GI complaints. Your next best step to treating the gallstones would be what? (TEST QUESTION).

Answer 20

LEAVE IT ALONE