Hepatobiliary 1- Paulson

Question 1

The 5 F’s, Fat, Female, Forty, and Fair Skinned refer to which disease?

Answer 1

Cholelithiasis (Gallstones)

Question 2

What is a sign of Cholelithiasis (Gallstones)?

Answer 2

-Biliary colic: intense, dull discomfort, usually in RUQ that may radiate to the back (esp. R shoulder blade).

• Often associated with N/V
• Lasts 30 min, peak 60, subsides
• triggered by eating a fatty meal

Question 3

How do you dx Cholelithiasis (Gallstones)?

Answer 3

U/S

Question 4

When you see an acoustic shadow on U/S, what may you think of?

Answer 4

Cholelithiasis (Gallstones)

Question 5

If a pt is asymptomatic with Cholelithiasis (Gallstones) what is the tx?

Answer 5

Watch and wait, can do pain management like NSAIDs or opoids (Tordol common)

Question 6

Treatment for typical biliary sxs + gallstones?

Answer 6

• Pain management during acute attack (NSAIDs or opioids)

- Cholecystectomy or medical dissolution of stones

Question 7

Treatment for atypical biliary sxs + gallstones?

Answer 7

-Lower relief rates after cholecystectomy than those with typical symptoms + stones

Question 8

If a patient has typical symptoms of gallstones but no stones visualized what might they have?

Answer 8

functional bladder disorder

Question 9

Acute inflammation of the gallbladder usually characterized by RUQ pain, fever, and leukocytosis

Answer 9

acute cholecystitis can be calculous (w/ stones) or acalculous (no stones)

Question 10

How to distinguish cholelithiasis from acute cholecystitis?

Answer 10

Cholelithiasis usually lasts 30-60 min whereas acute cholecystitis lasts about 4 hours

Question 11

Positive murphy’s sign

Answer 11

acute cholecystitis

Question 12

A patient presents with RUQ pain that radiates to her back, a fever, nausea after she just ate a big mac. She is guarding when she comes into the office. What could be the likely cause?

Answer 12

acute cholecystitis

Question 13

Leukocytosis and elevation of LFTs is in what disease?

Answer 13

acute cholecystitis

Question 14

How do you dx acute cholecystitis?

Answer 14

U/S

Question 15

Stones support the dx but gallbladder wall thickening or edema is the telltale sign in what dx?

Answer 15

acute cholecystitis

Question 16

If your acute cholecystitis is unclear, what test should you do next?

Answer 16

HIDA Scan

A + test is if the gallbladder is not visualized

Question 17

Treatment for acute cholecystitis?

Answer 17

• Hospital admit
• pain control
• abx
• cholecystectomy or cholecystotomy

Question 18

What abx should be given to a patient with mild-mod acute cholecystitis?

Answer 18

3rd gen cephalosporin (cefalozin, ceftriaxone)

Question 19

What abx should be given to a patient with severe acute cholecystitis?

Answer 19

broad spectrum (pip-tax or any combo, could do cipro + metronidazole)

Question 20

What abx should be given to a patient with health-care associated acute cholecystitis?

Answer 20

broad spectrum + vanco

Question 21

When would you do a cholecystectomy or cholecystotomy?

Answer 21

• Have progressive s/s such as high fever, hemodynamic instability, or intractable pain
• Suspicion for gallbladder gangrene or perforation

Question 22

What is the difference between a cholecystectomy or cholecystotomy?

Answer 22

Cholecystectomy- remove gallbladder -ectomy = removal

Cholecystotomy- surgical incision to remove a gallstone

Question 23

This type of cholecystits occurs after repeated acute cholecystitis episodes that leads to scarring and fibrosis of the gallbladder wall?

Answer 23

Chronic cholecystitis

Question 24

What sxs are associated with Chronic cholecystitis?

Answer 24

multiple episodes with biliary colic

Question 25

Treatment for Chronic cholecystitis?

Answer 25

Cholecystectomy

Question 26

This is calcification of the gallbladder wall and is associated with cholelithiasis in >95% people

Answer 26

Porcelain gallbladder

Question 27

Why do we care about porcelain gallbladder?

Answer 27

Patients are at increased risk for gallbladder carcinoma

Question 28

Treatment of Porcelain gallbladder?

Answer 28

Resection