GI

Question 1

How do you dx cholelithiasis?

Answer 1

U/S = TOC

Also CT or MRI

Question 2

How do you treat cholelithiasis?

Answer 2

Obs if asx
Ursodeoxycholic acid to dissolve stones
Elective cholecystectomy

Question 3

What is Charcot’s triad?

Answer 3

fever/chills
RUQ pain
jaundice

seen in acute cholangitis

Question 4

What is Reynold’s triad?

Answer 4

Chacot’s triad + shock & AMS

seen in acute cholangitis

Question 5

How do you dx acute cholangitis? What is gold standard?

Answer 5

leukocytosis
increased alkphos w/ increased GGT & bilirubin
U/S, CT
Cholangiography: GOLD via ERCP or PTC

Question 6

How do you treat acute cholangitis?

Answer 6

Ampicillin/sulbactam, pipercillin/tazobactam OR
Ceftriaxone + metronidazole OR
FQ + metronidazole
Decompression/stone extraction via ERCP

Question 7

What organisms cause acute cholecystitis?

Answer 7

E.coli MC

Klebsiella, Enterococci

Question 8

What are sx of acute cholecystitis?

Answer 8

RUQ/epigastric pain continuous

Nausea, precipitated by fatty foods or large meals

Question 9

What does acute cholecystitis look like on PE?

Answer 9

Fever

Enlarged palpable gallbladder, + Murphy’s

+ Boas sign (referred pain to R shoulder/subscapular area - phrenic nerve irritation)

Question 10

How do you diagnose acute cholecystitis? What is TOC vs gold standard?

Answer 10

U/S = Initial TOC
CT, abd xray
Increased WBCs, bilirubin, alkphos, LFTs
HIDA = GOLD

Question 11

How do you treat acute cholecystitis?

Answer 11

NPO, IVF, Abx (ceftriaxone + metronidazole) –> cholecystectomy

NSAIDs or narcotics