Gallbladder Flashcards
A hormone that is released when food is released by the stomach into the duodenum.
It is the main stimulant causing the gallbladder to contract and the Sphincter of Oddi to relax.
Cholecystokinin
Smooth muscles that surrounds the end portion of the common bile duct and pancreatic duct. This muscles relaxes during a meal to allow bile and pancreatic juice to flow into the intestine.
Sphincter of Odds
What happens when the Common Bile Duct is obstructed due to a stone.
Usually Non-Distended Gallbladder
→ because of previous fibrosis
What happens when the Common Bile Duct is obstructed due to malignancy?
Distended Gallbladder
What is the medical term for Gallstones?
Cholelithiasis
Why do Statins reduce the risk of Gallstones?
High Lipids → Gallstones
Statins decrease LDL → Less Gallstones
Who is most likely to have Gallstones?
Women
- Multiparous > nulliparous
What causes Gallstone formation?
↑ Cholesterol
↑ Bilirubin
Not enough Bile Salts
Incomplete or Infrequent Emptying
Type of Gallstones that occur when cholesterol exceeds the solubilizing capacity of bile, it can no longer remain dispersed and forms solid crystals.
Cholesterol-Crystalline
(Cholesterol Monohydrate)
- Most Common in the U.S.
Type of Gallstones caused by disorders that cause high levels of Bilirubin in Bile.
Pigment Stones
(Bilirubin Calcium Salts)
Pain from impaction of Gallstone at the neck of Gallbladder or Cystic Duct
Biliary Colic
What triggers Gallbladder Contraction?
Fatty Meals
What is the first line imaging for the diagnosis of Gallstones?
Abdominal Ultrasound
What imaging is indicated if the diagnosis remains uncertain for Gallstones after an Ultrasound?
HIDA Scan
- Hepatobiliary Iminodiacetic Acid
What is the normal ejection fraction of the Gallbladder and how is it determined?
Normal = > 35%
(HIDA Scan)
How do you manage Gallstones?
Avoid Triggers
Diclofenac (NSAIDs)
CHOLECYSTECTOMY for SIGNIFCIANT SYMPTOMS
How do you treat Gallstones in a patient that is symptomatic but they are not a candidate for surgery?
Ursodeoxycholic Acid
- given for 2 years
What does a Cholecystectomy increase the risk of?
Adenocarcinomas
Acute inflammation of the Gall Bladder.
Usually a complication of gallstone disease.
Acute Cholecystitis
Where do Gallstones become lodged in Acute Cholecystitis?
Cystic Duct
Acute Cholecystitis Symptoms
RUQ + Epigastric Pain
- often after fatty meals
Acute pain improves over 12-18 hours
Nausea, Vomiting, Anorexia
FEVER IS ALMOST ALWAYS PRESENT
What type of fever would suggest Acute Cholecystitis?
Low Grade Fever
- high fever → ascending cholangitis
Lab Findings of Acute Cholecystitis
Leukocytosis with a Left Shift
Amylase mildly elevated
Elevation of Serum Total Bilirubin and Alk Phos. are not common in uncomplicated cases.
How do you diagnose Acute Cholecystitis?
Abdominal Ultrasound
- more sensitive for stones
HIDA Scan
- if Gallbladder is not observed within 60 minutes with a normal tracer, a dose of Morphine is given
CT Scan
- may show complications of acute cholecystitis such as perforation or gangrene
MRI
- high sensitive but not cost effective; not typically used
Diagnostic Criteria for Acute Cholecystitis
Tokyo Guidelines
≥ 1 local sign + ≥ 1 systemic sign of inflammation
Local → Murphy Sign or RUQ Pain
Systemic → Fever, WBC, CRP
Acute Cholecystitis Complications
Gallbladder Gangrene
Cholecysto-intestinal fistula
Intestinal Obstruction
Gallstone Ileus
