Gallbladder Flashcards
40 year old obese woman presents with RUQ pain, heartburn, nausea, diarrhea, fever, and bloating. Pain is aggravated by fatty food. Referred pain to the right shoulder, scapula, and mid-back. Dx?
Gallbladder disease
Positive murphy’s sign might indicate…
gallbladder tenderness from infection, like acute cholecystitis, cholelithiasis
Labs ordered for RUQ pain
CBC, LFT, lipase
Diagnostic tests for RUQ pain
US, HIDA, EGD, CT (EGD and CT used to r/o other causes of RUQ pain)
Cholelithiasis
gallstones
cholecystitis
inflammation/infection of gallbladder
biliary dyskinesia
dysfunction of the gallbladder
choledocholithiasis
gallstones in the bile ducts
most common organisms in acute cholecystitis
klebsiella, e.coli, and strep
Biliary colic aka…
chronic cholecystitis
types of stones in cholelithasis
75% are cholesterol stones, 25% are pigment stones
tx of symptomatic cholelithiasis or acute cholecystitis
laparoscopic cholecystectomy
acute vs. chronic cholecystitis leukocytosis
chronic usually does not have elevated WBC’s, acute does
Most common complication of acute cholecystitis
pericholecystic abscess
acute cholecystitis tx and alternatives
usually laparoscopic cholecystectomy just like in symptomatic cholilithiasis. If poor candidate of surgery, do drainage via cholecystostomy tube. Or put patient on IV antibiotics (means of delaying surgery)
Biliary dyskinesia test results
US negative, HIDA shows decreased ejection fraction
Tx of biliary dyskinesia
avoid food triggers, bentyl, levbid, laparoscopic cholecystectomy
10% of patients that get laporoscopic cholecystectomy done in biliary dyskinesia will not improve- what to do?
Make sure EGD is done in this population
Acute cholecystitis not involving stones is…
acalculous cholecystitis
emphysematous cholecystitsi
acute cholecystitis caused by a gas producing anaerobe (clostridia)
Gallbladder hydrops
gallbladder obstructed by a stone and filled with clear liquid
Patient presents with RUQ pain, jaundice, F/C, dark urine, pruritis. Elevated liver enzymes, gallstone pancreatitis. Diagnosis?
choledocholithiasis
Tests done for choledocholithiasis
MRCP, PTC, ERCP, and IOC
Prior to using ERCP, what must resolve?
Pancreatitis
What procedures should be avoided in patient with cholangitis?
Cholangiogram (imaging of bile ducts by Xrays) such as PTC or ERCP
Types of cholangitis
Bacterial/suppurative cholangitis, sclerosing cholangitis, recurrent pyogenic cholangitis
Causes of bacterial cholangitis
Bacterial infection of the bile ducts caused by stone, neoplasm, stricture
Charcot’s triad
Fever/chills, RUQ pain, jaundice- in bacterial cholangitis
Patient presents with RUQ pain, jaundice, fever, and chills. Elevated WBC, elevated bilirubin and alkaline phosphate. LIkely diagnosis?
Bacterial cholangitis
Patient presents with RUQ pain, jaundice, fever, and chills. Elevated WBC, elevated bilirubin and alkaline phosphate. Patient also in shock and in confusion. Likely diagnosis?
Suppurative cholangitis
Tx of bacterial cholangitis
IV antibiotics. if that doesn’t work, decompress the bile duct with PTC, surgery, or endoscopic sphincterotomy
ERCP shows stenosis and “beading” of bile ducts. Patient has mild pruritis, jaundice and UC. You suspect…
Sclerosing cholangitis
Sclerosing cholangitis
Nonbacterial inflammatory narrowing of hte bile ducts
What role does E. coli have in recurrent pyogenic cholangitis?
E. coli initiates pigment stone formation in the bile ducts
What is gallbladder carcinoma associated with in 70% of cases?
Gallstones
What cancer involves the ducts of the liver?
cholangiocarcinoma
Patient presents with mass in RUQ and tenderness. Persistent RUQ pain, jaundice, worse with fatty food. Dx?
gallbladder carcinoma
