Gallstone dz Flashcards
Composition
Primary cz of cholesterol stones
Must have
cholesteol (majority)
Pigmented- Ca and bilirubin
inc chol in biliary tract
usually hypersecretion
Prolonged retention of bile for cholesterol stones to form
Pigment stones inc with
hemoglobin breakdown
Cholecystitis
Biliary stasis encourages
This results in
Stone obstruct of cystic duct, irritation of epithelium
proliferation of bacteria, usually from duodenum
cholangitis or acute pancreatitis
Most pts are
Rf for cholesterol stones
Pigment stones formed in
asx
inc cholesterol secretion to BD, inc gallbladder stasis, dec sec of bile acids, age
hemolytic states/cirrhosis
Most common sx
Biliary colic CM
Acute cholecystitis pain
physical exam
Choledocholithiasis
Acute cholangitis
sx
Biliary colic
pain after fatty meals
prolonged RUQ/epigastric, const sx
+ murphy, ab guarding
prolonged RUQ pain/epigastric, const sx
may be palpable
high fever, RUQ pain, jaundice (charcots triad)
HypoTN, mental status change
Dx
Cholecystitis lab values
Elevation of alkphos/bilirubin indicate
Acute cholangitis labs
clinical suspicion indicates
US
Left shift Leukocytosis (inc band forms), inc AST/ALT
gallstone in CBD
inc AlhPhos/biliubin
ERCP
Mx
asx cholelithiasis
biliary colic
acute cholecystitis
acute colangitis
no intervention
NSAID/aceto, elective laparoscopic cholecystectomy
IV fluids, pain control, Ab against Entero/anaerobes
cholecystectomy
Biliary decomp/Ab IV fluids ERCP/sphincterotomy stent/drain cholecystectomy
Prognosis
Comps include
most recover in 7 days
Empyema, necrosis, perforation
