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23 Cards in this Set

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1) What are the hallmark symptoms of gallbladder disease?




2) What are the hallmark symptoms of acute cholecystitis?




3) What are the hallmark symptoms of chronic cholecystitis?

1) Biliary Colic is the main symptom: This is RUQ pain that is post-prandial.




2) RUQ or epigastric pain that persists >8 hours




3) RUQ or epigastric pain that persists and is recurrent

What denotes the progression of biliary colic to acute or chronic cholecystitis?

U/S evidence of thickened gallbladder wall and usually elevated leukocyte count.

What are the complications of gallstone disease when the stones do not pass out of the gallbladder?

Acute or Chronic Cholecystitis

What are the most common cause of infections of acute cholecystitis?


  • E. Coli
  • Klebsiella
  • Proteus
  • Streptococcus Faecalis

What are the complications of a stone passing out of the gallbladder?

  • Pancreatitis
  • Choledocholithiasis
  • Cholangitis
  • Gallstone Ileus

1) Is a gallstone ileus an ileus?




2) Where is the most common site of a gallstone ileus?

1) Nope. An ileus is defined now as a lack of propulsion. A gallstone ileus is a mechanical obstruction.




2) Ileocecal valve.

What is the treatment of biliary colic?


  • NSAIDs for analgesia
  • Look at possible electrolyte imbalance from vomiting. Treat with antiemetics like zofran or dramamine
  • Offer Elective cholecystectomy

What is the treatment of acute cholecystitis?

  • Hospital Admission
  • NPO
  • IV Fluids
  • IV Antibiotics (Zosyn, Unasyn, Merrem, Primaxin for severe life threatening symptoms)
  • Cholecystectomy during admission

1) What is Acalculous Cystitis?




2) What percent of acute cholecystitis is caused by this?

1) It is cholecystitis that is caused by bile stasis and NOT gallbladder stones. This type of cholecystitis leads to gallbladder distension and decreased perfusion. It causes a more critical course of disease.




2) Very rare. Only 5% of patients with acute cholecystitis have no stones.

1) What is the general difference in pathology of cholecystitis and cholangitis?




2) What are the hallmark symptoms of Cholangitis?

1) Cholangitis is inflammation of the bile ducts, whereas cholecystitis is of the gallbladder.




2) Charcot's Triad: (RUQ Pain, Jaundice, Fever)


This only occurs in 70% of patients though.

What is the treatment strategy of cholangitis?

1) For mild-moderate cases then supportive care and antibiotics are indicated.




2) For severe cases then endoscopic decompression of the bile ducts by ERCP is indicated.

What does ERCP stand for?!?

Endoscopic Retrograde cholangiopancreatography.



What is the usefulness of RUQ U/S in diagnosing Choledocholithiasis?

It is used to measure the Common Bile Duct diameter (distentions would suggest choledocholithiasis) even though 50% of the time the stones are not visualized.

What is the role of Biliary Scintigraphy?

IV radioactive tracer is used to visualize the path of bile from the liver to the gallbladder then into the duodenum.




If the gallbladder isn't visualized this suggests gallbladder dysfunction caused by acute or chronic cholecystitis.

1) What is endoscopic sphincterotomy in the duodenum?




2) What is it indicated for?

1) During ERCP the sphincters (pancreatic, biliary, duodenal) can be decompressed to allow for forward flow.




2) Cholangitis, Choledocholithiasis

What are the two types of gallbladder stones?

Cholesterol or pigmented stones (bilirubin)

1) In a patient with RUQ pain, what findings would differentiate Choledocholithiasis from biliary colic?




2) How is the hospital course different for a patient with diagnosed choledocholithiasis vs biliary cholic?

1) U/S findings would show increased diameter of the CBD and also elevated liver enzymes.


RUQ U/S showing >5mm CBD diameter AND elevated liver enzymes.




2) Those with evidence of choledocholithiasis should be observed for development of cholangitis.

1) In a patient with RUQ pain, what findings would differentiate Choledocholithiasis from biliary pancreatitis?




2) What is the treatment of biliary pancreatitis?




3) What is the recurrence rate of pancreatitis with biliary pancreatitis?

1) Elevated Amylase and Lipase values IN ADDITION to CBD diameter >5mm, elevated liver enzymes.




2) Cholecystectomy




3) 25% in 6 weeks

Biliary Colic


1) Symptoms


2) Physical Examination


3) U/S


4) Laboratory Findings

1) Postprandial Pain <6 hours


2) Afebrile, mild tenderness over gallbladder


3) Gallstones but no wall thickening and no CBD dilation


4) Normal WBC, Normal Serum Amylase, Normal LFTs

Acute Cholecystitis


1) Symptoms


2) Physical Examination


3) U/S


4) Laboratory Findings

1) Persistant epigastric pain OR RUQ pain lasting > 8h


2) Febrile or afebrile. Localized gallbladder tenderness on palpation


3) Gallstones in gallbladder. May have pericholecystic fluid, may or may not have CBD dilation


4) Normal or elevated WBC count, May have normal or mildly elevated LFTs

Chronic Cholecystitis


1) Symptoms


2) Physical Examination


3) U/S


4) Laboratory Findings

1) Persistent or recurrent RUQ pain


2) Afebrile, may have localized tenderness over a palpable gallbladder


3) Gallstones, thickened gallbladder wall. In advanced cases gallbladder may be contracted.


4) Normal WBC, Normal-Mild LFT elevation

Choledocholithiasis


1) Symptoms


2) Physical Examination


3) U/S


4) Laboratory Findings

1) Postprandial pain that improves with fasting


2) +/- jaundince, nonspecific RUQ tenderness


3) gallstones, dilated CBD


4) Elevated LFTs

Biliary Pancreatitis

1) Symptoms

2) Physical Examination

3) U/S

4) Laboratory Findings

1) Persistent epigastric and back pain


2) Epigastric tenderness to deep palpation


3) Gallstones. +/- CBD dilation


4) Elevated WBCs, Serum amylase > 1000, Elevated LFTs may be transient or persistent. Persistent suggests CBD stones.