gallbladder disease Flashcards
what stimulates CCK release into bloodstream
fat
what stimulates contraction of GB
CCK
what is the diagnostic imaging modality?
IV injection of a radiotracer that is excreted by liver into bile and into GB.
List 3 things it can evaluate
HIDA
non-filling GB, leaks after surgery & measure CCK ejection fraction (33% + is normal)
a HIDA scan that shows non-filling GB at 4 hours is diagnostic for? how does this condition cause non-filling?
acute cholecystitis– pressure builds up to the point that bile wont flow in via ducts of luschka
what is the condition? imaging? Treatment?
- persistent,progressive RUQ pain that may wrap around the R side; may have fever
- Positive Murphy’s sign
- Leukocytosis/elevated WBC; mildly elevated bili,AST/ALT, ALP, etc.
acute cholecystitis
- US first– wall thickening, distention, pericholecystic fluid
- HIDA would show non-filling
- tx: URGENT cholecystectomy, IV abx (Metro + cephalosporin or fluoroquinolone); if too sick then cholecystostomy tube
- non-invasive specialized MRI to evaluate the intra/extra-hepatic biliary ducts
- ordered if not obvious that there is a stone or a complication, if concern for mass
MRCP
what is acute cholecystitis in one sentence (what is causing it and where)
- persistent inflammation & infection of gallbladder d/t gallstone obstruction at the cystic duct
- pain often precipitated by large or fatty meal (d/t CCK release causing GB contraction)
- cannulation of the biliary tree through direct visualization via side viewing endoscope
- diagnostic & therapeutic– stone removal, stenting, sphincterotomy, Bx, brushings, US
ERCP
only study that is both diagnostic and therapeutic for choledocolithiasis
ERCP
procedure where you insufflate abdomen, place ports using the bottom up technique
laparoscopic chole
tx used only in poor surgical candidates where you use ursodiol for 2 yrs to eliminate gallstones. it reduces cholesterol saturation of bile and only for stones under 5mm
- has high recurrence rate
dissolution therapy
what is the condition? imaging? Treatment?
- usually asymptomatic; sx of episodic RUQ pain that can also be associated with meals
- normal labs
Acute cholelithiasis
US
Observation if asymptomatic/incidental; cholecystectomy if symptomatic
describe cholelithiasis in one sentence. what are the 3 types?
- gallstones in gallbladder
- Cholesterol–most common; mixed
- Black– hemolysis or alcohol
- brown– infection
- sludge–thick bile
3 things sludge is associated with
TPN
starvation
rapid weight loss
what is the condition? Treatment?
- intermittent (1-4hrs) RUQ pain worse after fatty meals; may wrap around R side
- dyspepsia
- No fever
- normal labs
- US: stones; possible mild wall thickening
chronic cholecystitis
elective lap cholecystectomy
what are the two severe cases of acute cholecystitis? what is the treatment for both?
acute gangrenous cholecystitis
acute emphysematous
tx: broad spectrum abx + emergent cholecystectomy
“emphy-see-matous”
a severe case of acute cholecystitis with higher leukocytosis, systemic illness, may see perforation on imaging
acute gangrenous cholecystitis
a severe case of acute cholecystitis that is secondary to gas forming bacteria, more common in older ppl or ppl w/ DM, may see air in the GB wall on XR
acute emphysematous cholecystitis
what is the condition? imaging? Treatment?
- critically ill patient (on TPN, ventilator, etc) where taking history & P.E is difficult but has increasing leukocytosis of unknown origin & mild LFT elevation
acalculous cholecystitis
US: distention, thickening, fluid, maybe murphy’s sign
tx: may need cholecystotomy tube secondary to other issues
what is the condition? imaging? Treatment?
- non-specific RUQ pain, light stools w/ dark urine, jaundice
- high direct bilirubin, ALP, GGT - mild increase in AST/ALT
choledocholithiasis
US(dilated CBD), MRCP, ERCP
tx: monitor to see if it passes, if not then- ERCP or cholecystectomy if that fails
describe acalculous cholecystitis
necroinflammatory gallbladder disease NOT from gallstones; from stasis and ischemia
what is choledocholithiasis in simple words
gallstones in the common bile duct
what is the condition? Imaging? Treatment?
- charcots triad + reynolds pentad
- left shift leukocytosis; neutrophil predominance
- elevated ALP,GGT, direct bili, LFT
cholangitis
US/CT, MRCP,ERCP
tx: emergent ERCP or surgery
what is charcot’s triad & reynolds pentad
- Jaundice
- RUQ pain
- chills & fevers
reynolds pentad - altered mental status
- hypotension
