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15 Cards in this Set

  • Front
  • Back
Cholelithiasis
GB stones
Biliary Colic
Acute Cholecystitis
Management
Choledocholitiasis
CBDSBiliary Colic
Acute Cholangitis
Management
Clinical Implications
Biliary Pancreatitis
Bile leak
Three types of Gallstones
. Cholesterol (> 50% cholesterol) = 80%

2. Brown pigment: (Calcium Bilirubinate & Palmitate)
->INFECTION secondary to biliary sepsis

3. Black pigment: (Calcium Carbonate & Phosphate)
->Hemolysis (Sickle Cell Disease)
cirrhosis/alcoholism
Gallstone Formation- Risk Factors:
F's: Fat Fertile Forty Female
Obesity (>30% over IBW)
Female gender
Ethnicity
Native American
Hispanic
Total parenteral nutrition
Rapid weight loss
Pregnancy
Age (>40)
Cholelithiasis/Biliary Colic
Rarely symptomatic
85% asymptomatic
Stone impacts cystic duct temporarily blocking
Classic symptoms
RUQ
Radiates to back or shoulder
1-2 hours post prandial
Fatty meals are classic
Pain crescendos then plateaus and slowly subsides
Can be associated with nausea and vomiting
Biliary colic diagnostic options
Abdominal ultrasound
Computed Tomography
Nuclear study
Cholelithiasis Abdominal Ultrasound
Excellent to detect gallstones
Advantages:
Easy
Available
No radiation
Test of choice for suspected cholelithiasis
Hepatobiliary Scintigraphy
not good for detecting gallstones, good for detecting duct obstruction
Acute cholecystits
Gallbladder wall inflammation with fever, leukocytosis, and acute RUQ pain
Prolonged or recurrent cystic duct obstruction leading to GB wall inflammation
Not completely understood
Minimal AST/ALT elevation,
T Bili slightly elevated.
Normal amylase/lipase
Classic Murphy’s sign
Palpation of the RUQ upon inspiration induces pain
Acut Cholesystitis Dx
clinical features
Ultrasonography: 88% sensitive, 80% specific
Nuclear studies: 97% sensitive 90% specific for cystic duct obstruction
Computed tomography: typically required only if complicated cholecystitis is suspected
Management of Biliary colic and Acute cholecystitis
Biliary Colic- elective surgery
Acute Cholecystitis- Early Surgery.
Cholidochlithiasis
Symptoms similar to biliary colic
Typically associated with elevations of liver function tests in association with pain
Increased T.bilirubin, alkaline phosphatase, AST/ALT
Acute Cholangitis- Charcot's Triad
1)RUQ / epigastric pain
2)Jaundice
(Cholestatic picture with increased AST/ALT)
3) Fever
Biliary Pancreatitis
Features of pancreatitis clinically. Classically pain that radiates to the back with nausea, vomiting, anorexia
May have mixed cholestatic/hepatic liver enzyme pattern
Elevations in WBC, amylase, lipase
Endoscopic emergency if biliary obstruction is evident
Elevated total bilirubin= ERCP