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gallbladder Flashcards

1
Q

incidence of gallstones

A

by age 75, 35% of women and 20% of men

30% of people will have symptomatic disease

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2
Q

.what is acute cholecystitis

organisms

A

gallstone obstruction of the cystic duct

leads to chronic inflammation

e coli most common. klebsiella and gm neg organisms

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3
Q

.colicky epigastic pain or RUQ pain becoming steady and increases in intensity. often occurs after a high fat or large meal

*post prandial abdominal pain, assoc with N/V

A

acute cholelcystitis symptoms

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4
Q

.+ BOAs sign

A

acute cholecystitis

referred pain of right shoulder or subscapular area (phrenic nerve irritation)

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5
Q

.labs and imaging to order for acute cholecystitis

A

*HIDA scan most accurate test (cholecystitis present if no visualization of gallbladder)

u/s initial test of choice

bilirubin levels with increase after 24hrs and leukocytosis common, increased LFTs and alk phos

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6
Q

HIDA scan and ERCP for what

A

gallstone

HIDA to confirm

ERCP to identify cause, location, and extent of biliary obstruction

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7
Q

what is acute ascending cholangitis

A

potentially deadly condition of “common bile duct” obstruction combined with ascending infection due to gallstones or malignancy

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8
Q

.charcots triad

A

RUQ tenderness, jaundice, fever/chills. occurs in 50-70% of acute cholangitis

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9
Q

pt has charcots triad and also altered mental status and hypoTN

A

sepsis with acute cholangitis

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10
Q

elderly presentation of acute cholangitis

A

confusion, falls, and incontinence

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11
Q

.incidence of acute ACALCULOUS cholecystitis

describe

r/f

A

10% of acute cholecystitis

gallballer stasis and ischemia

critically ill pts

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12
Q

.initial management tx for acute cholangitis (3)

A

antibx (FQ+flagyl, piperacillin/tazobactram, ampicillin/sulbactram, gentamycin + ampicillin, ceftriaxone + flagyl)

followed by CBD decompression and stone extraction once stable ERCP

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13
Q

.what is primary sclerosing cholangitis

r/f

A

diffuse fibrosis of the intra and extrahepatic biliary ducts

IBS: UC 90%

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14
Q

.80% of primary sclerosing cholangitis is associated with what

A

inflammatory bowel disease, generally UC

10% of pts with UC will develop PSC

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15
Q

ge.nder and age of primary sclerosing cholangitis

A

men 20-40

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16
Q

.sx of primary sclerosing cholangitis

A

jaundice and pruritis most common

hepatomegaly and/or splenomegaly on exam

fatigue, malaise, wt loss

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17
Q

.primary sclerosing cholangitis

accurate test

labs

avoid what

A

labs: increased alk phos and ggt. ast/alt, bilirubin, igM increased

hallmark: positive P-ANCA

MRCP, ERCP(most accurate test) “beading” mulitiple bile duct strictures

avoid liver bx

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18
Q

.tx for primary sclerosing cholangitis

A

localized strictures relieved with balloon dilation and stent placement

cholestyramine for pruritis

liver transplant is the only tx with a known survival benefit

19
Q

complications of gallstones

A

cholecystitis

pancreatitis

acute cholangitis

20
Q

tx of acute cholecystitis

non op pt

A

fluids, antibiotics(ceftrixone + flagyl), then ccy sx

cholecystostomy (perc drainage)

21
Q

acute cholelcystitis symptoms

radiation

other mild symptoms

A

colicky epigastic pain or RUQ pain becoming steady and increases in intensity. often occurs after a high fat meal

radiation to rt shoulder or subscapular area

N/V, low fever are common

constipation and mild paralytic ileus may occur

22
Q

acute cholangitis organisms

other causes

A

E coli, enterococcus, klebsiella, enterobacter

can lead to sepsis and death

most often caused by choledocholithiasis,

or neoplasms, post op strictures, other causes of obstruction

23
Q

reynolds pentad

A

charcot triad

altered mental status

hypotension and shock

all indicate sepsis!! fatal!!

think cholangitis

24
Q

primary sclerosing cholangitis is strongly associated with what

A

cholangcarcinoma (10-30% of pts) as well as with an increased risk of pancreatic and colorectal carcinoma

25
Q

secondary tx for acute cholangitis

A

[ECRP for drainage and cholecystectomy]

ECRP for drainage, sphincterotomy, stone removal, and stent placement when pt is stable

percutaneous transhepatic biliary drainage or surgical biliary drainage may be required

cholecystectomy should be performed after the acute syndrome is resolved when a stone is present

26
Q

.5 F’s for gallstones

A

female

fat

forty

fertile

fair

27
Q

additional risk factors:

OCP use, rapid wt loss, TPN,

chronic hemolysis(pigment stones in sickle cell disease),

small bowel resection(loss of enterohepatically circulated bile)

A

gallstones

28
Q

.acute cholecystitis

symptoms(3) and exam(1)

A

RUQ pain, N/V, low fever

murphy sign, boa’s sign

29
Q

.murphy sign

A

inspiratory arrest with deep palpation of RUQ

acute cholecystitis

30
Q

risk factors:

native american

DM

pregnancy

crohns

female

obesity

A

risk factors for cholecystitis

31
Q

RUQ ultrasonography

increased alk phos and bilirubin

leukocytosis with left shift

ERCP: “beading” mulitiple bile duct strictures

liver bx: “onion skinning” periductal sclerosis

A

tests for primary sclerosing cholangitis

32
Q

.why are most gallstones not radiopaque

A

cholesterol

33
Q

confusion, falls, and incontinence

A

elderly presentation of acute cholangitis

34
Q

.incidence of acute ACALCULOUS cholecystitis

dx test and tx

A

u/s initial test

contrast enhanced abd CT if u/s is uncertain

HIDA is still uncertain

supportive tx

35
Q

.acute ascending cholangitis organisms

s/s

A

e coli most common. klebsiella 2nd.

charcots triad and reynolds pentad

36
Q

.acute ascending cholangitis

dx labs/imaging

cholestasis

A

u/s initial

cholangiography via ERCP is gold standard

labs: leukocytosis with poss left shift.

cholestasis: increased alk phos and ggt, increased bilirubin > increased ast/alt

37
Q

.ERCP can be performed when

A

once the patient has been afebrile/stable for 48 hours after IV antibx

38
Q

.what is cholelithiasis

A

gallstone in biliary tract without inflammation. may get colic abruptly with fatty meal.

39
Q

.what are black and brown stones

A

black: hemolysis or alcohol related cirrhosis: increased in asian population, parasitic, or bacterial infections

40
Q

.what is choledocholithiasis

s/s and tx

A

gallstone in common bile duct

prolonged biliary colic, jaundice

ercp for dx(after u/s) and tx

41
Q

.primary biliary cirrhosis/cholangitis disorder of what

age/gender

A

intrahepatic bile ducts that leads to decreased bile salt excretion, cirrhosis, end stage liver ds

women middle aged

42
Q

.primary biliary cirrhosis/cholangitis disorder

s/s PE

A

most asymptomatic, incidental finding of high alk phos

fatigue 1st symptom, pruritis, RUQ discomfort

PE: hepatomegaly, jaundice.

43
Q

.primary biliary cirrhosis/cholangitis disorder hallmark dx

A

antimitochondrial antibody.

u/s initial imaging test

bx definitive

GI (14 decks)

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