OnlineMedEd: Surgery: General - "Gallbladder" Flashcards
Most gallstones are ____________.
mixed cholesterol and bilirubin
Review the risk factors for gallstones.
- Female
- Forties
- Fat
- Fertile
- Familia (this is a twofer: FMH and Hispanic heritage)
The classic presentation of gallstones is _______________.
colicky RUQ that radiates to the shoulder, wose with fatty foods
The first step in diagnosing cholelithiasis is __________.
RUQ US
How should you treat cholelithiasis?
Elective cholecystectomy
Nonsurgical candidates should be given bile salts (ursodeoxycholic acid).
What US signs indicate cholecystitis?
- Pericholic fluid
- Gallbladder wall thicker than 3 mm
- Gallstones
Murphy’s sign indicates _____________.
cholecystitis (not -lithiasis!)
The advantage of HIDA is ___________.
proof that the cystic duct is occluded
Most of the time, the stone in cholecystitis cannot be seen on US. The HIDA scan will show failure to fill resulting from a blocked cystic duct.
How do you treat cholecystitis?
- NPO
- IVF
- Antibiotics
- Urgent (within 72 hours) cholecystectomy
If the person is not a surgical candidate, do a cholecystostomy.
Describe how choledocholithiasis differs from cholecystitis?
Jaundice, hepatitis, and pancreatitis may also present
Review the workup of suspected choledocholithiasis.
1) RUQ US
2) If the RUQ US is inconclusive, get a MRCP
How is choledocholithiasis treated?
ERCP and then cholecystectomy (for temporary and definitive treatment)
Cholangitis presents with _________’s triad: _____________.
Charcot’s; fever, jaundice, and RUQ
(“CHolAngiTis = CHArcoT)
Remember Reynold’s pentad: AMS and hypotension with the above.
The diagnostic and therapeutic workup of cholangitis is _______________.
ERCP (done after RUQ US demonstrates suspicion)
The infection will persist as long as the stone is blocking the common bile duct.
Also do NPO, IVF, and abx.
After ERCP, those with cholangitis need to _____________.
get cholecystectomy
