Gallbladder

Question 1

4 F’s of gall stones?

Pt will present with what type of pain with gall stones?

Answer 1

Female, 40s, fat, and fertile

Colicky pain in RUQ that radiates to shoulder

Question 2

How to diagnose gallstones?

Answer 2

RUQ US

Question 3

What is the most common cause of cholecystitis?
Big identifier on US?
Physical exam identifier?
What is the pain like?

Answer 3

Gall stone stuck in cystic duct
Thickened wall
Positive Murphy’s sign
Constant now because its inflammation, always there

Question 4

What do you do next if you are suspecting cholecystitis and the RUQ US doesn’t show you what you want?

Answer 4

HIDA scan

Looking for the gallbladder not to fill

Question 5

How to treat gall stones and how to treat cholecystitis?

Answer 5

Gall stones is elective surgery

Itis is surgery urgent with abx right away

Question 6

What is choledocolithiasis?

Answer 6

Stone is stuck in the common bile duct

Question 7

What are the 5 things that the patient can present with when the gall stone is stuck in the common bile duct?

Answer 7

If it is far enough down it can cause
1. Pancreatitis, elevated amylase and lipase
2. Hepatitis, elevated AST and ALT
3 painful jaundice
4. Murphys sign
5. Inflammation

Question 8

How to diagnose choledoco?

How to treat?

Answer 8

RUQ US looking for obstruction with dilated ducts. If negative, MCRP

ERCP urgently
Take out gallbladder electively

Question 9

What is charcots triad for cholangitis?

What two additional things added equal Reynolds Pentad?

Answer 9

RUQ pain
Fever
Jaundice

Hypotension
AMS

Question 10

How to diagnose and treat cholangitis?

Answer 10

RUQ US and then ECRP

Question 11

Two abx to give together for all the biliary tree infections?
Old triple therapy i might see?

Answer 11

Cipro and metro

Ampicillin, gentamicin and metro