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Gastrointestinal System > EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS > Flashcards

EXAM #3: CHOLELITHIASIS AND CHOLECYSTITIS Flashcards

1
Q

What is unique about the Gallbladder in terms of its anatomy?

A

Enlarges as it approaches the skin

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2
Q

Where is the Gallbladder best found?

A
  • Right costal margin in the mid-clavicular line
  • RLQ
  • Tip of right 11th rib
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3
Q

What is the normal function of the gallblodder?

A

Stores and concentrates bile

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4
Q

What mediates the muscular contraction and sphincter opening of the Gallbladder?

A

CCK (made in duodenum)

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5
Q

Where does Gallbladder pain radiate to?

A
  • Right back

- Shoulder

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6
Q

Why does the Gallbladder pain radiate to the back and shoulder?

A

Viscerosomatic reflexes

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7
Q

What are the risk factors for gallstone formation?

A

1) Age
2) Female
3) Family hx
4) Native American
5) Obesity
6) Multiparity
7) Rapid weight loss
8) Hemolytic disease
9) Alcohol
10) Estrogen
11) TPN
12) Cholesterol binding resins

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8
Q

What are the different types of gallstones?

A
  • Cholesterol-mixed
  • Pigmented
  • Sludge
  • Single large
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9
Q

What is the composition of a cholesterol-mixed gallstones?

A
  • Cholesterol
  • Bile salts
  • Lecithin
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10
Q

What is a pigmented gallstones composed of?

A

Calcium bilirubinate

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11
Q

What is sludge?

A
  • Mucoprotein
  • Calcium bilirubinate
  • Cholesterol
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12
Q

What composes a single large gallstones?

A

Cholesterol

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13
Q

What causes the undulating pattern of gallbladder pain seen with gallstones?

A

1) CCK induced let down

2) Stone obstructs and then FALLS back

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14
Q

Where do gallstones commonly stick?

A

Common bile duct

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15
Q

What are the signs and symptoms of gallstones?

A
  • RUQ pain
  • Worse after eating (high fat food)
  • Murphy’s sign +
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16
Q

What are the clinical types of cholecystitis?

A
  • Acute
  • Chronic
  • Ascending cholangitis
17
Q

What are the signs of acute cholecystitis?

A

1) Unrelenting pain
2) Fever
3) RUQ pain
4) Ass. nausea and vomiting

18
Q

What are the signs of chronic cholecystitis?

A

Intermittent pain and well between bouts

19
Q

What is Ascending Cholangitis?

A

Infection of the small intestine ascending into the biliary tree

20
Q

What is a calculous gallstones?

A

US positive stone

21
Q

What is an acalculous stone?

A

US negative for stone but positive for:

  • Thickened BW wall
  • Fluid in GB fossa
22
Q

What is a positive sonographic Murphy’s Sign?

A

Murphy reproduced with US probe

23
Q

What labs can be elevated in cholecystitis?

A
  • Total bilurubin

- Lipase if obstruction leads to pancreatitis

24
Q

How is cholecystitis treated?

A

1) NPO
2) Hydration
3) Pain control w/ Ketorolac

25
Q

What warrants admission with cholecystitis?

A

1) Impacted stone
2) Septic
3) Unrelenting pain
4) Mimic or uncertain

26
Q

What do you do if there is a negative US and clinical suspicion of gallstone?

A

HIDA

27
Q

What is a HIDA scan?

A

Nuclear med. functional study of the hepatobillary tree

28
Q

What are abnormal findings on a HIDA scan?

A

1) Non-filling i.e. obstruction
2) Non-emptying i.e. porcelain gallbladder
3) CCK sx.

29
Q

What are some of the medical therapies for cholecystitis?

A

1) Ursodiol–decrease cholesterol absorption
2) ESWL shock waves
3) Contact dissolution

30
Q

What are the quasi medical therapies for cholecystitis?

A

1) ERCP

2) Transcutaneous drain

31
Q

What are the surgical procedures for cholecystitis?

A

1) Cholecystectomy

2) ERCP

32
Q

What do you need to remember about the elderly and cholecystitis?

A
  • Atypical presentation

- High mortality

33
Q

List some of the conditions that mimic cholecystitis.

A
  • Acute inferior wall MI
  • Subdiaphragmatic abscess
  • RLL pneumonia
  • Appendicitis
  • Hepatitis
  • Pericarditis
  • PUD
  • Pancreatitis
34
Q

What are the important complications of gallstones to keep in mind?

A

1) Gallstone ileus (Gallstone–>obstruction)

2) Gallstone pancreatitis

35
Q

What is Charcot’s triad of cholangitis?

A

1) Jaundice
2) Fever
3) RUQ pain

36
Q

What should you do if patient comes to the ED with a surgical complication?

A

Call the surgeon

Gastrointestinal System (42 decks)

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