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10 Cards in this Set

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What treatment steps are appropriate for patients with cholecystitis or cholangitis?
1. For cholecystitis or cholangitis, start broad-spectrum IV antibiotics to cover gram-negative enterics, gram-positives (Clostridium, enterococcus) and anaerobes (Bacteroides).

2. Volume resuscitate as needed.

3. Patients with cholecystitis may respond to antibiotics alone and warrant elective cholecystectomy
look for on a physical exam to indicate cholecystitis or cholangitis?
For both cholecystitis and cholangitis:

1. Fever
2. Tachycardia
3. Hypotension
4. RUQ pain
5. Guarding

Peritoneal signs are usually absent.

Jaundice is a feature of cholangitis, but is absent in cholecystitis.

50% of patients with cholecystitis have a palpably enlarged gallbladder
What are the complications of cholecystitis?
1. empyema
2. gangrene
3. gallbladder perforation with a mortality of 30%
The classic exam finding for cholecystitis is Murphy's sign. How do you elicit it?
Palpate the liver edge deeply at the midclavicular line and ask the patient to inhale. When the inflamed gallbadder meets the hand, the patient abruptly stops breathing in. Unfortunately, sensitivty and specificity are low for this maneuver.
How does cystic duct occlusion (cholecystitis) present?
Cystic duct occlusion occurs as postprandial right upper quadrant pain, worse with fatty food ingestion, as much as 3-4 hours after eating. It commonly occurs at night between 10pm and 2am. It can be intermittent or progressive.

If blockage persists, pain becomes steady, often radiating to the right shoulder. High fever is rare.
What are the risk factors for gallstones (cholecystitis)?
The classic patients with gallstones is "fat, fertile, forty and female", a derogatory but accurate characterization of the risk factors.
Progressive parenchymal fibrosis, associated w/ alchoholism/cholecystitis, can have calcifications & pseudocysts
Chronic pancreati
What is a priority for a pt admitted w/cholecystitis & cholelithiasis Sympts.acute RUQ pain that radiates to her back, N/V.
Medication for N/V due to cholecystitis
Compazine, Meclazine, and Tigan
Clinical manifestations of cholecystitis are
N/V, low-grade fever, biliary colic pain, and right upper quadrant guarding; pain radiates to the right scapula.