Gallstone dz Flashcards Preview

Gastro 1 > Gallstone dz > Flashcards

Flashcards in Gallstone dz Deck (8)
Loading flashcards...
1
Q

Composition

Primary cz of cholesterol stones

Must have

A

cholesteol (majority)
Pigmented- Ca and bilirubin

inc chol in biliary tract
usually hypersecretion

Prolonged retention of bile for cholesterol stones to form

2
Q

Pigment stones inc with

A

hemoglobin breakdown

3
Q

Cholecystitis

Biliary stasis encourages

This results in

A

Stone obstruct of cystic duct, irritation of epithelium

proliferation of bacteria, usually from duodenum

cholangitis or acute pancreatitis

4
Q

Most pts are

Rf for cholesterol stones

Pigment stones formed in

A

asx

inc cholesterol secretion to BD, inc gallbladder stasis, dec sec of bile acids, age

hemolytic states/cirrhosis

5
Q

Most common sx

Biliary colic CM

Acute cholecystitis pain
physical exam

Choledocholithiasis

Acute cholangitis

sx

A

Biliary colic

pain after fatty meals

prolonged RUQ/epigastric, const sx
+ murphy, ab guarding

prolonged RUQ pain/epigastric, const sx
may be palpable

high fever, RUQ pain, jaundice (charcots triad)
HypoTN, mental status change

6
Q

Dx

Cholecystitis lab values

Elevation of alkphos/bilirubin indicate

Acute cholangitis labs
clinical suspicion indicates

A

US

Left shift Leukocytosis (inc band forms), inc AST/ALT

gallstone in CBD

inc AlhPhos/biliubin
ERCP

7
Q

Mx

asx cholelithiasis

biliary colic

acute cholecystitis

acute colangitis

A

no intervention

NSAID/aceto, elective laparoscopic cholecystectomy

IV fluids, pain control, Ab against Entero/anaerobes
cholecystectomy

Biliary decomp/Ab
IV fluids
ERCP/sphincterotomy
stent/drain
cholecystectomy
8
Q

Prognosis

Comps include

A

most recover in 7 days

Empyema, necrosis, perforation