UW cholecystitis

Question 1

acalculous cholecystitis, an acute inflammation of the gallbladder in the absence of gallstones.

Answer 1

.

Question 2

Acalculous cholecystitis most commonly occurs in what patients?

Answer 2

critically ill patients (eg, those with sepsis, severe burns, trauma, immunosuppression) and is associated with high mortality.

Question 3

why manifest acalculous in critically ill patients?

Answer 3

secondary to gallbladder stasis and ischemia, which cause inflammation of and injury to the gallbladder wall.

Question 4

what sign positive in acalculous?

Answer 4

positive Murphy’s sign

Question 5

intrumental diagnosis of acalculous?

Answer 5

The diagnostic study of choice is an ultrasound, which may show signs of acute cholecystitis (eg, an edematous and enlarged gallbladder) and no gallstones.

Question 6

acalculous: Fever, RUQ pain, a positive Murphy’s sign, leukocytosis, and mild elevations in liver function tests are often present. Physical examination may demonstrate jaundice and a palpable RUQ mass

Answer 6

.

Question 7

Calculous. location of obstruction?

Answer 7

gallstone obstruction of the cystic duct.

Question 8

Calculous. what episodes of pain?

Answer 8

Symptoms are often preceded by transient episodes of abdominal pain and nausea after fatty meals due to temporary cystic duct obstruction (biliary colic).

Question 9

Calculous. Persistent gallbladder outflow obstruction promotes what?

Answer 9

promotes hydrolysis of luminal lecithins to lysolecithins

Question 10

Calculous. hydrolysis disrupts what?

Answer 10

the protective mucus layer.

Question 11

Calculous. once protective mucus layer is damaged what happens?

Answer 11

The luminal epithelium is then exposed to the detergent action of the bile salts, resulting in chemical irritation and prostaglandin release

Question 12

Calculous. What causes hypomotility of bladder?

Answer 12

The increasing distension and internal pressure within the gallbladder eventually result in ischemia.

Question 13

Calculous. what invades bladder?

Answer 13

bacteria (eg, Escherichia coli, Enterococcus, Klebsiella, Enterobacter) invade the injured and necrotic gallbladder wall, causing an infection.

Question 14

Calculous. what inflammatory mediators occur?

Answer 14

lysolecithin, prostaglandins

Question 15

Calculous. secondary bacterial infection.

Answer 15

.

Question 16

Calculous. complications?

Answer 16

Potential complications include gangrene and perforation, with subsequent formation of a pericholecystic abscess or generalized peritonitis.

Question 17

Calculous. EIGA: Subsequent steps in pathogenesis include mucosal disruption by lysolecithins, bile salt irritation of the luminal epithelium, prostaglandin release with transmural inflammation, gallbladder hypomotility, increased intraluminal pressure causing ischemia, and bacterial invasion.

Answer 17

.

Question 18

Calculous. imaging diagnostics?

Answer 18

Ultrasonography is the preferred.

however, nuclear medicine hepatobiliary scanning (ie, cholescintigraphy aka HIDA scan) can be an alternate means when ultrasonography is inconclusive.

Failure to visualize gallbladder on HIDA scan suggests obstruction.

Question 19

Chronic cholecystitis. What predispose?

Answer 19

Chronic cholecystitis results from repeated mild attacks of acute cholecystitis, which leads to thickening of the gallbladder wall.

Question 20

Chronic cholecystitis. ultrasound presentation?

Answer 20

Ultrasound typically demonstrates a shrunken, fibrosed gallbladder.

Question 21

Porcelain gallbladder. presentation of gallbladder?

Answer 21

firm, palpable gallbladder and extensive calcification throughout the gallbladder wall.

Gross findings include a bluish, brittle, thickened gallbladder wall with a “crunchy” texture.

Question 22

Porcelain gallbladder. imaging?

Answer 22

thickened gallbladder wall with a rim of patchy or uniform calcification.

Question 23

Porcelain gallbladder. pathogenesis?

Answer 23

The pathogenesis is due to dystrophic intramural deposition of calcium salts in the setting of chronic inflammation.

Question 24

Porcelain gallbladder. microscopy?

Answer 24

Microscopic findings can include calcified plaques within the muscularis or spotty calcification in the mucosa.

Question 25

Porcelain gallbladder. increase risk of what?

Answer 25

Porcelain gallbladder is associated with an increased risk of adenocarcinoma of the gallbladder.

Question 26

Choledolithiasis. What is it?

Answer 26

presence of gallstones in common bile duct (ductus choledocus).

Question 27

Lab in Choledolithiasis?

Answer 27

inc. ALP, GGT, direct bilirubin, and/or AST/ALT (mild)