Surgery

Question 1

When to remove a gallbladder and when to delay

Answer 1

• gallstones with intermittent biliary colic: elective chole
• ## complicated gallstone disease (cholecystitis, choledocho, or gallstone pancreatitis): w/in 72hrs

Question 2

When to get a HIDA scan?

Answer 2

When the answer “hides” from you on U/S - aka when I/S is indeterminate for finding the gallstone and you still wonder if it’s in the CBD

Question 3

How sick is someone with spontaneous bacterial peritonitis?

Answer 3

They can appear not-that-sick, but still have severe SBP; especially think SBP in someone with chronic ascites.
Criteria include temp >100, HOTN, paralytic ileus (may have some s/sx of SBO but it’s NOT SBO), AMS, diffuse abdominal pain W/O rigidity or rebound.
*Differentiate from alcoholic hepatitis which has RUQ pain, SBP has diffuse pain

Question 4

How to differentiate Bladder dome and neck rupture

Answer 4

dome = signs of chemical peritonitis like diffuse abd tenderness, guarding, rebound; pelvic frx less common
neck = gross hematuria w/ Foley, localized pelvic/suprapubic tenderness, also urinary retention; usually associated with pelvic fracture