General Surgery/GIT / Gallbladder Disease Flashcards
Calcium gallstones are the most common type. True or false?
False. 80% are cholesterol stones
What are the risk factors for gallstones?
- Age >40 years
- female gender
- pregnancy
- oral contraceptive or estrogen replacement therapy
- obesity
- rapid weight loss
- Native American ethnicity
- family history of 1st degree relatives with gallstones
- “Fat, female, forty, and fertile”
What is biliary colic?
Recurrent RUQ pain from the gallbladder contracting against a gallstone in the gallbladder outlet
Where does the pain from biliary colic radiate?
To the back or right shoulder
Can gallstones be seen on plain abdominal x-ray?
Only 10% of gallstones have enough calcium to be radiopaque
In patients with a typical history of biliary colic but no evidence of gallstones on ultrasound, what other diagnostic tools can be used?
- CT of the abdomen
- HIDA scan
- bile microscopy
- endoscopic ultrasound
How should patients with biliary colic and gallstones on ultrasound be treated?
- Pain control with meperidine or NSAIDs
- elective cholecystectomy
Why is meperidine preferred over morphine in patients with biliary symptoms?
It causes theoretical decreased Sphincter of Oddi spasm.
Is surgery indicated for the asymptomatic patient with incidental gallstones on ultrasound?
No
What is the implication of finding a calcified gallbladder (porcelain gallbladder) on imaging?
- Increased risk of malignancy
What are the complications of gallstones?
- Acute cholecystitis
- ascending cholangitis
- acute biliary pancreatitis
- gallstone ileus
- gallbladder cancer
What sign is positive when a patient has severe pain and inspiratory arrest with palpation in the area of the gallbladder?
Murphy sign
What are the key lab findings of acute cholecystitis?
Leukocytosis with a left shift
What ultrasound findings support a diagnosis of acute cholecystitis?
- The presence of gallstones with gallbladder wall thickening
- pericholecystic fluid or
- a sonographic Murphy sign
How should acute cholecystitis be treated?
- IV fluids
- NPO status
- pain control with opioids or ketorolac
- empiric antibiotics
- cholecystectomy
What is the name for cholecystitis in the absence of gallstones (5%-10%, or cases of acute cholecystitis)?
Acalculous cholecystitis
What groups of patients are especially at risk for acalculous cholecystitis?
- Critically ill patients or
- following major surgery or trauma
- patients on total parenteral nutrition (TPN)
What is the name for the triad of fever, jaundice, and RUQ pain found in ascending cholangitis?
Charcot triad
What lab findings are consistent with ascending cholangitis?
- Leukocytosis with left shift
- elevated alkaline phosphatase, gammaglutamyl transpeptidase (GGT), and conjugated bilirubin
Reynold pentad of altered mental status, hypotension, fever, jaundice, and RUQ pain is found in what condition?
Supparative cholangitis
What percentage of patients with gallstone disease develop pancreatitis?
5%
What percentage of acute pancreatitis is caused by gallstones?
33%
In what patient population is gallstone ileus most common?
Elderly patients
