DSA 3: Gallbladder & Biliary Tree Flashcards
What part of the abd will hurt for GB dzs (what are all the DDx related to this)
RUQ: GB disease
- Acute cholecystitis
- Choledocholithiasis
- Ascending cholangitis
- Biliary dyskinesia
- Chronic cholecystitis
- Primary sclerosing cholangitis
How do you perform Murphy’s sign and what is a (+) sign
ask pt to exhale, examiner places hands below costal margin on R side at mid-clavicular line; ask pt to inspire
Pt stop breating in and winces w/ a “catch” in breath bc of inflammed GB palpation on inspiration
what are the types of stones in cholelithiasis
2 major types of gallstones =
- cholesterol (80%)- >50% cholesterol monohydrate
- pigment stones (20%)- primarily Ca2+ bilirubinate; brown stones form in bile duct bc of bacterial infxn (30-90% gallstones in Asians)
what are signs and symptoms of cholelithiasis
- biliary colic - severe steady ache in RUQ/epigastrium suddenly (often after meal)- occasionally radiate to R scapula
- N/V
what imaging and labs will confirm the diagnosis for cholelithiasis
Lab = normal or occasionally (mild/transient) elevation in bilirubin
Imaging: Ultrasongraphy is the best Dx test (RUQ US/hepatobiliary US) - stones seen as “acoustic shadow” that they cast
What are complications of cholelithiasis
cholecystitis, pancreatitis, cholangitis
what are RFs for gallstones
6 F’s: FHx, Fair, Fat, F, Fertile and Forty
Female, increase w/ age, obesity, pregnancy
american indians > mexican americans > non-hispanic whites > african-americans
DM, glucose intolerance, insulin resistance, hyper triglycerides, high intake of carb
MALE > FEMALE IF CIRRHOSIS & HEP C
What are protective factors for gallstones
low carb diet, high fiber diet, statins, ASA & NSAIDs
consumption of coffee (in women)
physical activity, cardioresp fitness
high intake Mg2+ and polyunsaturated & monosaturated fats (in men)
what are the 2 types/causes for acute cholecystitis
caculous: > 90% , impacted in the cyst duct; inflam GB develops behind the obstruction
acalculous: true cholecystitis + no stones; many acute illnesses, vascultitis, carcinoma, some GB infxns
What are signs and symptoms of acute cholecystitis
large fatty meals can cause acute attack
epigastric/RUQ tenderness (often w/ murphy’s sign)
sometimes jaundice
tea-colored urine or acholic stools
What labs and imaging help to diagnose acute cholecystitis
labs: leukocytosis, bilirubinemia, increase ALP & GGT
imaging: RUQ abd ultrasonography - GB wall thickening, pericholecystic fluid & sonographic Murphys sign
what are complications of acute cholecystitis
gangrene of the GB - may lead to GB perforation –> pericholecystic abscess –> generalized peritonitis
emphysematous cholecystitis (2ndary infxn w/ gas-forming organism)
What is essential for diagnosis of choledocholithiasis
what signs will be added to make you think ascending cholangitis
choledocholithiasis: stones in common bile duct (CBD) - most reliably detected by ERCP or EUS, N/V, biliary pain +/- jaundice
AC - fever, N/V, jaundice & leukocytosis, biliary pain +/- jaundice & gram-neg shock
What are signs/symptoms of choledocholithiasis
- freq recurring attacks of severe RUQ pain x hours
- chills/fever associated w/ severe pain
- Hx of jaundice associated with episodes of abd pain
(can lead to acute ascending cholangitis - AC)
what imaging/labs help to Dx choledocholithiasis
imaging: most direct, accurate = ECRP - help determine cause, location and extent of obstruction *do INR prior to ERCP*
labs: increase in AST/ALT, slow increase in ALP and GGT