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year 5 - GIT surgery > management of symptomatic and complicated gallstones > Flashcards

management of symptomatic and complicated gallstones Flashcards

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1
Q

what is cholelithiasis ?

A

gallstones in the gallbladder

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2
Q

what is the most common presentation of cholelithiasis ?

A

mostly asymptomatic

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3
Q

what are the types of gallstones ?

A

cholesterol
pigment
mixed

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4
Q

what are brown pigmeent stones associated with ?

A

related to bile stasis and infected bile

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5
Q

what are black pigment stones associated with ?

A

hemolysis
thalassemia
hereditary spherocytosis
sickle cell disease

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6
Q

patients with cirrhosis have a higher chance of which type of stones ?

A

black pigmented stones

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7
Q

what are cirrhosis and hemolytic disease associated with black pigment stones ?

A

with hemolytic diseases haem is broken down into bilirubin
with cirrhosis there is a higher concentration of unconjugated bilirubin

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8
Q

what is ezetimibe ?

A

highly selective intestinal cholesterol absorption inhibitor to prevent the formation of cholesterol gallstones

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9
Q

how do statins work to decrease the formation of cholesterol gallstones ?

A

statins competitively inhibit HMG-CoA

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10
Q

high levels of what hormone are. associated with cholesterol pigment formation ?

A

leptin

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11
Q

what’s the difference between cholangitis , cholecystitis and cholelithiasis ?

A

cholelithiasis - gallstone
cholecystitis - inflammation of the gallbladder
choledochlithiasis - CBD stone
cholangitis - inflammation of the billiary tree

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12
Q

what increases the risk of ascending cholangitis ?

A

impacted gallstone in the distal bile duct

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13
Q

what is the treatment of asymptomatic gall-stones ?

A

observe
unless :
has a porcelain bladder
has a stone larger than 2-3 cm
is a pediatric patient
is immunocompromised

law kda perform cholecystectomy

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14
Q

when can prophylactic cholecystectomy be performed ?

A

patients with diabetes
congenital hemolytic anemia
undergoing bariatric surgery ( because rapid weight loss is associated with gallstone formation )
or patients prepared for organ transplantation

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15
Q

what is the most common cause of acute cholecystitis ?

A

Impacted Gallstone in Hartmann’s Pouch

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16
Q

what is the difference between biliary colic and acute cholecystitis ?

A

biliary colic - temporary impaction
acute cholecystitis - prolonged impaction

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17
Q

what is the presentation of biliary colic ?

A

epigastric pain
withiin 4 hours
nausea and no vomitingg
no fever
no tendderness
normal leukocyte count

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18
Q

where is the maximum intensity of biliary colic pain ?

A

maximal inn the epigastrium and right hypochondrium with radiation to the back

19
Q

if biliary colic does not resolve what happens ?

A

acute cholecystitis

20
Q

what are the types of acute cholecystitis ?

A

acute calculous cholecystitis
acute acalculous cholecystitis

21
Q

presentation of acute cholecystitis ?

A

right upper quadrant pain
referred to the tip of the shoulder or to the interscapular area
fever
nausea and vomitiing

22
Q

how to clinically differentiate between acute cholecystitis and acute cholangitis ?

A

cholangitis - must have fever and must have jaundice and high inflammatory markers ar 10 times fold

cholecystitis - no fever and no jaundice

23
Q

what two signs are associated with acute cholecystitis ?

A

Murphy’s sign
Boa’s sign - hyperesthesia at the 9th to the 11th rib posteriorly

24
Q

if there is a tender mass palpable in right hypochondrium with a complaint pointing towards cholecystitis what should u keep in mind ?

A

empyema of the gallbladder
omental phlegmon
abscess

25
Q

imaging used for cholecystitis ?

A

abdominal US

26
Q

when should HIDA scan be used ?

A

acalcular cholecystitis

27
Q

what is the non operative management of acute cholecystitis ?

A

NPO
nasogastric tube if vomiting
IV fluids
broad spectrum ab
IV analgesics
observation.

28
Q

when to perform lap cholecystectomy and when do we perform operative ?

A

laparoscopic is the gold standard
if presented after 3 days interval cholecystectomy after 6 weeks

29
Q

when should a cholecystectomy be performed in pregnant women ?

A

during the second trimester

30
Q

when should an emergency cholecystectomy be done ?

A

empyema, persistent or progressing symptoms

31
Q

what antibiotics should be used for empyema of the gallbladder ?

A

cefotaxime
ceftriaxone

32
Q

what is the most serious complication of acute cholecystitis ?

A

cholangitis

33
Q

what is the presentation of acute cholangitis and what is the etiology ?

A

charcot’s triad:
jaundice
RUQ pain
fever

etiology : gall bladder obstruction in the CBD

34
Q

what is the presentation of acute suppurative cholangitis ?

A

presence of pus in the bile ducts
charcot’s triad plus hypotension and confusion

35
Q

imaging for acute cholangitis ?

A

CBD and IHBR dilatation
MRCP
ERCP

36
Q

treatmeent for acute cholangitis ?

A

iv fluids cultures antiibiotics
deecompressiion by ERCCP

37
Q

If decompression by ERCP failed in acute cholangitis what is the next best step in management ?

A

PTBD
percutaneous transhepatic biliary drainage

38
Q

what is gallstone ileus ?

A

mechanical intestinal obstruction resulting from passage of large gallstone into bowel lumen

39
Q

nasogastric tube aspirate findings

A

bilious - lower GI bleeding
no bile - pylorus is competent and the bleeding is duodenal in origin
blood - upper GI bleeding

40
Q

what can be delivered by nasogastric tube ?

A

lactulose + neomycin - if variceal bleeding
colon preparation - cathertex

41
Q

fin a case -
gall bladder wall not thickened , this denotes ?

A

multiple gallstones with thickened. gall bladder due to fibrosis occurs in chronic calcular cholecystitis

42
Q

what is riglers triad ?

A

triad of :
pneumobilia
intestinal obstruction
gallstone in a weird place

43
Q

what is the pathogenesis of mucocele of the gallbladder ?

A

prolonged obstruction with no infection or inflammation

year 5 - GIT surgery (8 decks)

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