Gallbladder

Question 1

What are the signs and symptoms of cholelithiasis?

Answer 1

RUQ or epigastric pain (colicky and postprandial)
Pain may radiate to the shoulder
N/V

Question 2

What are the signs and symptoms of cholecystitis?

Answer 2

RUQ or epigastric pain (colicky and postprandial)
Pain may radiate to the shoulder
N/V
\+ Murphy's sign
Fever/chills may be present

Question 3

What are the signs and symptoms of cholangitis (inflammation of the biliary tree d/t bacterial infection from obstruction)?

Answer 3

Same as cholecystitis but more severe. They are sicker and can go into shock.
TRIAD: Fever, Abd pain & Jaundice

Question 4

What are some risk factors of gall bladder disease?

Answer 4

Fair, fat, female, 40, fertile, fatty foods, fast fat loss

Question 5

What labs are appropriate?

Answer 5

CBC
LFT (alk phos, bilirubin)
AST/ALT/Amylase/Lipase
Electrolytes (bun/cr)
HCG

Question 6

What is the best diagnostic tool to confirm cholelithiasis?

Answer 6

US - not contraindicated in PG

Check for US Murphy’s sign

Question 7

Treatment for cholelithiasis

Answer 7

Surgical intervention
Lifestyle modifications
Weight management
NSAIDS, antispasmodics, antiemetics while awaiting surgery

Question 8

Name 2 complications of cholelithiasis

Answer 8

1. Cholecystitis

2. Pancreatitis

Question 9

A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings?

a. Acute acalculous cholecystitis
b. Chronic cholelithiasis
c. Common bile duct obstruction
d. Infectious cholecystitis

Answer 9

ANS: C
This patient has symptoms of cholecystitis with bile duct obstruction, which causes jaundice. The common triad of RUQ pain, fever, and jaundice occurs when a stone in lodged in the common bile duct. Acute acalculous cholecystitis is inflammation without stones. Chronic cholelithiasis doesn’t cause acute symptoms; jaundice occurs with obstruction. Infectious cholecystitis may occur without obstruction.

Question 10

A patient with a previous history of liver disease has bile duct obstruction. Which procedure will be used for this patient?

a. Chemical dissolution of the gallstone
b. Lithotripsy
c. Open cholecystectomy
d. Laparoscopic cholecystectomy

Answer 10

ANS: C
Patients with possible liver disease should have open cholecystectomy. The other procedures are contraindicated. Chemical dissolution is not reliable and may take some time.

Question 11

A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which diagnostic test will the provider order?

a. Abdominal CT with contrast
b. Abdominal ultrasound
c. MRI of the abdomen
d. Plain abdominal radiographs

Answer 11

ANS: B
Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided.

Question 12

A patient has fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms?

a. Empiric treatment with antibiotics
b. Hospitalization for emergent treatment
c. Prescribing ursodeoxycholic acid
d. Supportive care with close follow-up

Answer 12

ANS: B
This patient has symptoms of acute acalculous cholecystitis, and is critically ill. Hospitalization is required. Empiric treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones.