GI Cases

Question 1

acute cholecystitis s/s

Answer 1

• RUQ tenderness
• guarding, wanting to lie flat
• NAV, fever, fatigue
• +MURPHY SIGN

Question 2

acute cholecystitis DDx

Answer 2

• biliary colic
• gall stones
• acute hepatitis
• pancreatitis
• PUD
• acute MI
• LRL pneumonia

Question 3

acute cholecystitis labs

Answer 3

• CBC: high WBC w/ neutrophil left shift
• CMP: CRP elevated due to inflammation
• pancreatic (amylase & lipase): normal
• hepatitis labs negative

Question 4

acute cholecystitis tests

Answer 4

• CXR: r/o pneumonia
• EKG: r/o cardiac
• US: gall bladder and pancreas
• HIDA scan
• CT

Question 5

acute cholecystitis tx

Answer 5

1. hospitalization
2. supportive:
   NS IV - 1L 30min, then 1L 2-4h, then 1/2 w/ 20meq K/L 100-110ml/h
   pain control - Ketorolac (Toradol) 30-60mg IV q6h; morphine 2.505mg IV q4h
3. Abx (G-/anaerob):
   Cefazolin/Ceftriaxone 1-2g IV q8h;
   Imipenem/Cilastatin 500mg IV q6h
4. surgery if ASA I or II