Gallbladder

Question 1

What does the gallbladder respond to?

Answer 1

Cholecystokinin (CCK)

Question 2

What is released from the gallbladder and what is its function?

Answer 2

Bile – function is to break up fats

Question 3

What is bile made up of?

Answer 3

Bile salts, bilirubin, and alkaline fluids

Question 4

What does cholecystic mean?

Answer 4

Referring to the GB

Question 5

What does cholecystitis mean?

Answer 5

Inflammation & stone in the cystic duct

Question 6

What does cholelithiasis mean?

Answer 6

Stones in the GB

Question 7

What does choledocholithiasis mean?

Answer 7

Stone in the bile duct

Question 8

What does cholecystectomy mean?

Answer 8

Surgical removal

Question 9

What does cholecystalgia mean?

Answer 9

Pain

Question 10

What is the majority of a gallstone made of?

Answer 10

Cholesterol

Question 11

If a patient presents with RUQ and epigastric pain, what diagnosis should immediately be on your differentials?

Answer 11

Cholecystitis

Question 12

Where does cholecystits pain radiate to?

Answer 12

Right shoulder/subscapular region

Question 13

What is occurring in cholecystitis?

Answer 13

Gallstone obstructing the cystic duct, leading to impaired venous return, which can become ischemic

Question 14

Can a patient have N/V with acute cholecystitis?

Answer 14

Yes

Question 15

What PE test can you perform for cholecystitis, what would you see?

Answer 15

Murphy’s sign – tenderness & patient stops inspiration on palpation of RUQ

Question 16

How do you confirm diagnosis of cholecystitis?

Answer 16

Ultrasound – see the gallstones & GB wall thickening!

Can also do a HIDA scan

Question 17

What labs would you want to order with cholecystitis? What would you typically see?

Answer 17

CBC (WBC = 12-15K), LFTs, Alkaline phosphatase, GGT, bilirubin, and amylase = all elevated

Question 18

What would the elevation of the LFT’s have to be to truly point us in the direction of a liver disorder?

Answer 18

At least 3x higher

Question 19

How would you treat cholecystitis?

Answer 19

Cholecystectomy! Could drain it if the patient is too ill. Abx if fever and/or leukocytosis

Question 20

The presence of a gallstone is known as? Where did it come from?

Answer 20

Cholethiasis

Comes from cholesterol

Question 21

Physiologically, what causes cholethiasis?

Answer 21

Bile become supersaturated with cholesterol, the cholesterol crystallizes, and the gallbladder is slow to empty.

Question 22

When would the gallbladder have the lowest hyPOmotility?

Answer 22

During pregnancy

Question 23

Who is most at risk of developing cholesthiasis?

Answer 23

The five F’s = female, fat, 40, fair, and fertile

Obesity (or rapid weight loss)

Question 24

Do people typically present with symptoms with cholesthiasis?

Answer 24

No, no symptoms usually until it becomes cholecystits

Question 25

How do you confirm diagnosis of cholesthiasis?

Answer 25

Ultrasound! – you will NOT see gallbladder wall thickening

Question 26

How do you treat cholesthiasis?

Answer 26

If it hurts, take it out. If not, leave it in. Unless there are other complications (reasons) to take it out – diabetes, sickle cell. Can dissolve stones with Ursodiol, Actigall, or Chenix

Question 27

What if on ultrasound, you see that the stone is located in the common bile duct (rather than the cystic duct) what is this known as?

Answer 27

choledocholithiasis

Question 28

How do you confirm diagnosis and treat choledocholithiasis?

Answer 28

ERCP

Question 29

If a patient presents with RUQ pain, jaundice, and fever, what diagnosis are you thinking?

Answer 29

Acute cholangitis → Charcot’s Triad!

Question 30

What would the symptoms be known as if the person also had an altered mental status and hypotension?

Answer 30

Reynold’s Pentad

Question 31

If Reynold’s Pentad is present in a patient with choledocholithiasis, what does that mean?

Answer 31

Indicates sepsis, can become rapidly fatal

Question 32

What is occurring during acute cholangitis?

Answer 32

Infection of the biliary tract due to obstruction → can lead to sepsis/shock

Question 33

What labs would you order for acute cholangitis? What would you see?

Answer 33

CBC – leukocytosis with left shift Hyperbilirubemia Elevated alkaline phosphatase

Question 34

How would you confirm diagnosis of acute cholangitis?

Answer 34

RUQ ultrasound (initial test) then ERCP

Question 35

How would you treat a patient with acute cholangitis?

Answer 35

Get 2 cultures to see what Abx it will respond to (floroquinolones) Remove obstructing stone with ERCP