Gallstone Diseases Flashcards
What is the most common type of gallstone made of?
Cholesterol
What is the most common color of gallstones?
Green - cholesterol
Who is at risk for gallstones made of cholesterol?
Female
Fat
Forty
Fertile
What is a lesser common type of gallstone made of?
Bilirubin
What is the color of a less common type of gallstone?
Black - bilirubin
What causes someone to have gallstones made of bilirubin?
Hemolysis
– Can occur in kids
Choledocholithiasis
Stone stuck in the common bile duct or pancreatic duct
How will the gallbladder look with choledocholithiasis?
Mostly unaffected but will possibly have stones within it
How will the common bile duct look with choledocholithiasis?
It will be dilated proximal to the stone
What is a sign a stone is stuck somewhere in the common bile duct/pancreatic duct that will not be present if the stone was stuck elsewhere?
JAUNDICE
What lab changes will be present with Choledocholithiasis?
HIGH Alk Phos and Bilirubin
+/- HIGH LFTs
What is the first diagnostic test for RUQ pain?
RUQ Ultrasound
Following an ultrasound, what is the order of things that should be done for Choledocholithiasis and related disorders? (3)
- MRCP
- ERCP
- Cholecystectomy
What is Ascending Cholangitis?
Choledocholithiasis + INFECTION of the biliary tree
Stone stuck in the common bile duct + infection of the biliary tree
Ascending Cholangitis
What is the Triad of symptoms that can present with Ascending Cholangitis?
RUQ pain
Fever
Jaundice
What is the Pentad of symptoms that can present with Ascending Cholangitis?
RUQ pain
Fever
Jaundice
Altered mental status
Hypotension
If you suspect Ascending Cholangitis, what diagnostics/treatment should you do?
SKIP the MRCP
–> ERCP, Cholecystectomy, ABx
What is Gallstone Pancreatitis?
Choledocholithiasis with stone stuck in the pancreatic duct + PANCREATITIS
What lab change will point you toward Gallstone Pancreatitis?
HIGH Lipase 3X upper limit of normal
For Gallstone Pancreatitis and Choledocholithiasis, what is the order of diagnostic tests/treatment that should be done?
- RUQ US
- MCRP
- ERCP
- Cholecystectomy
For Choledocholithiasis, Gallstone Pancreatitis and Ascending Cholangitis, what lab changes are commonly present?
HIGH Alk phos and Bilirubin
+/- HIGH LFTs/Lipase
Where is the stone stuck with Acute Calculous Cholecystitis?
Cystic Duct
Is the common bile duct affected with Acute Cholecystitis?
NO – just the gallbladder
Will jaundice be present with Acute Cholecystitis?
NO
Following a (-) RUQ US, what diagnostic test should be done for Acute Calculous Cholecystitis?
HIDA scan
What classifies a (+) HIDA scan?
Inability for tracer to enter the gallbladder
What 3 things will be seen on RUQ Ultrasound with Acute Calculous Cholecystitis?
- Gallstones
- Pericholecystic fluid
- Gallbadder wall thickening
In what patients does Acute Acalculous Cholecystitis occur?
Critically ill - receiving parental nutrition
What will be seen on RUQ ultrasound with Acute Acalculous cholecystitis?
- Pericholecystic fluid
- Gallbladder wall thickening
What is the treatment for Acute Calculous Cholecystitis? Acalcuous?
Calculous = Cholecystectomy + ABx
Acalcuous = Percutaneous Drain
What is Biliary Colic?
Symptomatic Cholelithiasis
Cholelithiasis
Gallstones in the gallbladder
What type of symptoms will be present with Biliary Colic?
RUQ pain that is worse after eating and fatty foods – episodic
What will be seen on RUQ ultrasound with Biliary Colic?
Gallstones ONLY
How does a Gallstone Ileus arise?
Gallstone passes through a biliary-enteric fistula
Where often is the obstruction with a Gallstone Ileus?
Gallstone lodges in the Ileum
Signs of a Gallstone Ileus?
BOWEL OBSTRUCTION
= Abdominal distention, N/V, constipation and pain
What will a CT scan show with Gallstone Ileus?
AIR in the BILIARY TREE
– dilated bowel/obstructing stone too
What will a CT scan show with Gallstone Ileus?
AIR in the BILIARY TREE
– dilated bowel/obstructing stone too
Common choice of antibiotic treatment for Acute Cholecystitis?
Piperacillin-Tazobactam
