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54 Cards in this Set
- Front
- Back
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What are the 5 F risk factors for gallstones?
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Female, Fat, Fertile, Forty, Farty
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What's your acronym for risk factors for gallstones?
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ABCC FFFF III SHORTV
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What is ABCC?
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-American-Native american
-Biliary stasis -Chronic hemolysis -Cirrhosis |
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What does III stand for?
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-Infection
-Ileal resection -IBD |
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What does SHORTV stand for?
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-Somatostatin therapy
-Hyperlipidemia -OCPs -Rapid weightloss -TPN -Vagotomy |
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What are the 3 most common types of gallstones and which is the MOST common?
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-Cholesterol stones 75%
-Black pigmented -Brown pigmented |
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What factors lead to cholesterol stone formation?
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Bile that is supersaturated with cholesterol, and decreased gallbladder emptying
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What are black pigmented stones made of and what causes them to form?
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Calcium bilirubinate - caused by cirrhosis and hemolysis in a sterile gallbladder
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What are brown pigmented stones like in composition and what causes them to form?
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-Soft, located in bile ducts
-Formed in infected bile |
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What is Biliary Colic?
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Pain caused by a TRANSIENT obstruction of the cystic duct with a gallstone
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What is acute cholecystitis?
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Unrelenting pain due to gallbladder inflammation caused by a gallstone obstructing the cystic duct
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What % of acute cholecystitis is due to stone vs acalculous?
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Stone - 95%
Acalculous - 5% |
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Where is the pain located in
-Biliary cholic -Acute cholecystitis |
Both - RUQ, epigastric, subscapular
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Which biliary pain tends to be poorly vs well-localized?
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Biliary cholic - poorly localized
ACC - well localized |
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What is the duration of pain in
-Biliary cholic -Acute cholecystitis |
BC - transient
ACC - unrelenting |
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What are some signs/sx of
-Biliary cholic -Acute cholecystitis |
BC - n/v/doubled up
ACC - n/v/ FEVER |
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What is the hallmark sign in
-Biliary cholic -Acute cholecystitis |
BC - Boas sign
ACC - Murphy's sign |
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What is Boas sign?
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Referred right subscapular pain
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What is Murphy's sign?
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Inspiratory arrest and sharp pain on palpating the liver when you have the patient inspire
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What are 4 bugs that typically cause acute cholecystitis?
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-E. coli
-Klebsiella pneumo -Strep faecalis -C welchii/perfringens |
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What lab findings are often seen in Biliary colic?
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None
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What lab findings are often seen in acute cholecystitis?
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-High WBC
-Sl high ALP -LFTs -Amylase/T-Bili |
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What is the treatment for biliary colic?
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Lap cholecystectomy
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What is the treatment for acute cholecystitis?
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-IVF
-NG decompression -Open or LAP Chole ASAP!!! |
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What is the initial study of choice for patients with biliary tract disease? Why?
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Ultrasound
-May show stones/sludge, thickened walls, and fluid |
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What are some disadvantages of US for biliary disease?
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-Not good for fat people
-Doesnt work for ascites/gas -Cant see stones in the bile ducts |
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How useful are abdominal films for gallstones?
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10-15% of stones are radioopaque and show up; can't use if pregnant obviously
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What are the 2 best ways to visualize gallstones in the biliary duct system?
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-ERCP
-PTC |
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What is ERCP?
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Endoscopic Retrograde Cholangiopancreaticography
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How is ERCP done?
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By injecting contrast into the GI tract, thru the sphincter of oddi, and into the biliary tree
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What is a disadvantage of ERCP?
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May dmg the sphnicter of oddi, and requires anesthesia
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What is PTC?
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Percutaneous transhepatic cholangiography
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How is PTC done?
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By injecting dye through the skin directly into the liver parenchyma
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What can be injected intravenously to visualize GB duct obstruction?
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HIDA/PRIDA
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What is HIDA/PRIDA?
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Using radiolabeled Iminodiacetic Acid injected into the bloodstream to see if it entersthe bile ducts and gb
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What tells you if there is a cystic duct obstruction on HIDA/PRIDA?
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Failure to see the labelled substance enter the gallbladder after 4 hours
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What is oral cholecystogram?
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Ingestion of an oral contrast agent that concentrates in the gallbladder, then visualized by XRaying the RUQ
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Is CT very good for gallbladder and biliary duct disease?
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no
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What is IV Cholangiography?
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IV Injection of Iodine-contrast
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What are 2 drawbacks to using IV cholangiography?
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-May cause anaphylactic rxn
-Contrast not excreted if the patient has jaundice |
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If a patient w/ gallstones developed jaundice, tea colored urine and acholic stools, what might you suspect?
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Choledocholithiasis
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What is choledocholithiasis?
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Gallstones that have moved out into the bile duct
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What are 6 possible complications of gb stones?
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-Choledocholithiasis
-Acute cholecystitis -Cholangitis -Gallstone ileus -Gallstone pancreatitis -Gallbladder cancer |
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What is Cholangitis?
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Bacterial infection of the biliary tract due to obstruction
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What are the triad/pentad in cholangitis?
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Charcot's triad
Reynold's pentad |
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What is Charcot's triad?
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Fever/chills
RUQ pain Jaundice |
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What is Reynold's pentad?
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Charcot's plus AMS/shock
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What exactly is Reynold's pentad seen in?
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Acute suppurative cholangitis
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What labs are elevated in Cholangitis?
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-WBC
-T-bili -ALP -AST -ALT |
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What is the treatment for suppurative cholangitis?
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-IVF
-Antibiotics -Decompression with ERCP, PTC, or T-tube placement |
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What is Gallstone ileus?
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SBO caused by a large gallstone thru the GB, passing to the GI tract via fistula where it gets impacted before the ileocecal valve
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How is Gallstone ileus diagnosed? (3 tests)
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Abd Xray - air in the biliary tree!!
US - sees the stone Barium study - biliary-intestinal fistula |
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What is the treatment for gallstone ileus?
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-Celiotomy
-Enterolithotomy -Cholecystectomy |
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What is Gallstone Pancreatitis caused by?
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Obstruction of the ampulla of vater by a gallstone, or biliary sludge.
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