Gallbladder Disease Flashcards
What is the dx method of gallbladder and biliary tract dis? (most sensitive examination to show gallstones)
U/s
Gold standard for dx of acute cholycystitis ?
Hida Scintigraphy Tc99
What are the cotraindications of ERCP ?
Patients with gastric resection bcz rod cant enter duodenum
What are the complications of ERCP ?
Pancreatitis
Cholangitis
Bleeding
Perforation
What is the clinical sign for cholylithiasis?
Murphy’s sign
Pain is from which nerve in murphy’s sign?
Phrenic nerve
What are symptoms of gallbladder dis?
Murphys sign
Itching
Jaundice
Vomiting nausea
Right upper quad pain
Risk factors of gallstones/
Females
*Obesity
Crohn’s
TPN
OC or Estrogen use
*morbid obesity surgeries
*Pregnancy
Vagotomy(removal of vagus)
indication for surgery in Asymptomatic cholelithiasis?
[the porcelain NOn-functioning gallbladder in diabetic and pediatric patients causes multiple millimetric stones and stones >2.5cm]
Diabetic pts
Non-functioning gallbladder
Multiple millimetric stones
Porcelain gallbladder
Pediatric patients (congenital hemolytic anemia, sickle cell anemia)
Patients with stones larger than 2.5cm
What is most common symptom of cholelithiasis?
Biliary colic; pain in murphy’s area due to biliary duct block
Clinical findings of gallstones?
Biliary colic(pain in murphy’s sign due to biliary duct blockage)
Gallbladder hydrops
Dyspepsia(indigestions)
Lab findings of acute cholecystitis?
Bilirubin ALP AST ALT are NORMAL
Murphy+
Leukocytosis >20,000
Tx in acute cholecystitis
Cholecystectomy
Interval cholecystectomy
Percutaneous or surgical
cholecystostomy: Especially in cholecystitis without stones
Which type of cholecystitis is in diabetic pts?
Emphysematous Cholecystitis
Which type of cholecystitis has no stones?
Acalculous cholecystitis
recurrent attacks of obstruction in biliary duct is known as?
Chronic cholecystitis
Which type of disease is caused by residual stone in common bile duct after forgeting to remove it in surgery?
Postcholecystectomy syndrome
Most common gallbladder cancer/biliary system?
Adenocarcinoma 90%
The first examination performed in a patient with jaundice is ……..***
USG
In the patient with jaundice, if nothing is palpable with an hydropicly gall bladder , the stone should be considered, and if something is palpable (pancreatic head) …… should be considered.***
tumor
The most effective and reliable method of showing gallstones is …..***
USG
The most common symptom of gallstones is ,,,,,, and the most common
complication is ………
biliary colic,
acute cholecystitis.
The most common cause of acute cholecystitis is …….. **
obstruction of the ductus cysticus
While the most specific, most sensitive method for the diagnosis of acute cholecystitis is …….., the most preferred method is …….***
HIDA scintigraphy
USG
What is charcot triad?
Detects cholangitis;
Right upper quadrant pain, Fever
Jaundice
What is the findings of most severe cholangitis?
Reynolds Pentate:
CHOLANGITIS
– Charcot triad + septic shock and neurological findings
The most common type of sclerosing cholangitis is the primary type of sclerosing cholangitis and is ………***
idiopathic
Cholangitis vs cholecystitis ?
Cholangitis is the inflammation of the bile duct system
Cholecystitis:is the inflammation of wall of gall bladder
Cholangitis is always accompanied with …..?
obstruction
Where is cholangiocarcinoma mostly found?
It can present anywhere in the biliary tract. 2/3 is in hepatic duct bifurcation (**Klatskin’s tumor) most common)
Symptoms of cholangiocarcinoma?
**painless jaundice
CA 19-09 is high**
Loss of appetite
Cholecystectomy is the tx choice for all gallbladder diseases except for …..
Cholangiocarcinoma stage 4; tx is transplantation
Dx in cholangiocarcinoma?
USG, CT
*PTC (in proximal lesions), *ERCP (in distal lesions)
What causes cholangiocarcinoma ?
Pimary sclerosing cholangitis
What is the difference between biliary colic and cholecystitis?
What to do in pt with cholecystitis?
Antibiotics and surgery and for dx senUSG or HIDI scintigraphy
Manifests as fever and signs of infection with stones visualized:
Cholecytitis
Which gall bladder disease manifests as AFEBRILE and will commonly have no abnormal vitals in contrast to acute cholecystitis or cholangitis
Biliary colic
The most sensitive examination. First choice in treatment used in Choledocolithiasis
ERCP
What is the most common type of sclerosing cholangitis ?
Primary type of sclerosing cholangitis &is idopathic
