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15 Cards in this Set
- Front
- Back
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Cholelithiasis
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GB stones
Biliary Colic Acute Cholecystitis Management |
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Choledocholitiasis
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CBDSBiliary Colic
Acute Cholangitis Management |
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Clinical Implications
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Biliary Pancreatitis
Bile leak |
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Three types of Gallstones
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. 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 |
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Gallstone Formation- Risk Factors:
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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) |
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Cholelithiasis/Biliary Colic
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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 |
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Biliary colic diagnostic options
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Abdominal ultrasound
Computed Tomography Nuclear study |
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Cholelithiasis Abdominal Ultrasound
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Excellent to detect gallstones
Advantages: Easy Available No radiation Test of choice for suspected cholelithiasis |
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Hepatobiliary Scintigraphy
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not good for detecting gallstones, good for detecting duct obstruction
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Acute cholecystits
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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 |
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Acut Cholesystitis Dx
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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 |
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Management of Biliary colic and Acute cholecystitis
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Biliary Colic- elective surgery
Acute Cholecystitis- Early Surgery. |
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Cholidochlithiasis
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Symptoms similar to biliary colic
Typically associated with elevations of liver function tests in association with pain Increased T.bilirubin, alkaline phosphatase, AST/ALT |
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Acute Cholangitis- Charcot's Triad
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1)RUQ / epigastric pain
2)Jaundice (Cholestatic picture with increased AST/ALT) 3) Fever |
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Biliary Pancreatitis
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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 |
