gallbladder disease Flashcards
what is cholelithiasis?
stones in the gallbladder
what is choledocolithiaisis?
stones in the common bile duct
what is it called when cholelithiasis becomes symptomatic?
gallbladder disease
what is cholecystitis?
infection of obstructed gallbladder
what is cholangitis?
infection of obstructed bile duct
what are the symptoms of cholelithiasis?
billiard cholic
- lasting under an hour
- constant
- radiating to back and shoulder
- nausea vomiiting and sweating
why do you get biliary cholic with cholelithiasis?
bc when the gallbladder contracts against gallstones it compresses the cystic duct
how can cholelithiasis be diagnosed?
- USS of right upper quadrant
- stones cast an acoustic shadow below the gallbladder
- they move freely when the individual turns-> distinguishes them form carcinoma
what are the risk factors for developing gallbladder cancer?
- gallstones >3cm
- calcified gallbladder
- gallbladder adenomas
what is treatment of gallbladder disease?
medical: symptom control with; - spasmolytic= butylscopalamine opioids= buponorphine treat with; ursodeoxycholic acid-> esp for those who are not eligible for surgery
ESWL- breaks stone down with shock waves
surgical:
- cholecystectomy
how does ursodeoxycholic acid work?
- decreases cholesterol absorption
- so stops new gallstones from forming
- dissolves existing gallstones
who is suitable for ESWL?
- less than 3 gallstones between 4-30mm contraindicated in... - pregnancy - cholecystitis - choledocolithiasis - pancreatitis - coagulopathies
what can be seen on examination of individuals with choledocolithiasis?
courvoisier’s sign-palpable gallbladder, since the obstructed common bile duct will cause the gallbladder to dilate
what are some associated issues you can have with choledocolithiasis?
associated pancreatitis:
- increase in amylase and lipase levels
associated hepatitis:
- ALT and AST are elevated
what are blood results like in choledocolithiasis?
- leukocytosis
- increased total bilirubin
- increase alanine phophotase
- increase glutamyl transferase
how can you diagnose choledocolithiasis?
- RUQ USS- dilated common bile duct and intrahepatic duct
- MRCP- magnetic resonance cholangiopancreatography
what is the treatment of choledocolithiasis?
- IV fluids to treat dehydration
- ERCP= endoscopic retrograde cholangiopancreatography- to remove stones
what is acalculus cholecystitis?
acute cholecystitis that is not caused by by gallstones
- often caused due to bile stasis
why can chronic cholecystitis cause porcelain gallbladder?
- because of continuous cycle of blockage and dislodging of gallstones there is intermittent injury to gall bladder walls and this causes them to calcify
this can lead to increased risk of gallbladder cancer r
what are clinical signs of acute cholecystitis?
murphy’s sign
- press down and ask px to breathe in- pain gets worse
how to diagnose acute cholecystitis?
USS- distended gallbladder, thickening of wall, fluid around
HIDA scan- radioactive tracer will show that gallbladder isn’t filling due to obstruction
what is treatment of acute cholecystitis?
NSAIDS- analgesic
IV fluid
antibiotics
gold standard= cholesectomy
cholecystectomy- if can’t have surgery- this allows gallbladder to drain out
what are clinical signs of cholangitis?
charcots triad
- RUQ pain
- jaundice
- fever
reynolds pentad (septic patients)
- hypotension
- altered mental status
- along with charcot’s triad
treatment of acute cholangitis
- fluids
- antibiotics
- ERCP
- cholecystectomy after gallstones have been removed
