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Session 3 CM- GI-7

CM- GI-7- Biliary Disease

What is cholelithiasis presence of stones in the gall bladder
Who is most likely to suffer from cholelithiasis female, pregnancy, pt > 40yrs, or w/ family history
What factors can predispose you to developing cholelithiasis obesity, oral contraceptives, diabetes, rapid weight loss, estrogen replacement tx, ileal disease, decreased physical activity
What ethnicities are more prone to suffer from cholelithiasis Hispanics, northern European and pima Indians, less common in African Americans except with sickle cell disease
If you have a pt on total parenteral nutrition what complication are they more prone to develop cholelithiasis
What test can you order to dx cholelithiasis oral cholecystography and Gallbladder ultrasound
This visualization technique is used to examine biliary tree (gallbladder, bile and pancreatic ducts) by combining x-ray and endoscopy useful for id of strictures and biopsy of lesions and gallstones Endoscopic Retrograde cholangiopancreatography ERCP
What visualization technique of the gallbladder uses radioisotopes Cholescintigraphy- HIDA scan hydroxy iminodiacetic acid scan
What does a HIDA scan show shows gallbladder activity not especially useful for seeing stones though
what is cholecystogram x-ray used to evaluate gallbladder
Who is more effected by cholecystitis Men are more affected than women though women get gallstones more than men
What are the s/sx of cholelithiasis 80% asymptomatic, upper right quadrant pain of constant boring quality, can also have referred pain to scapular or supracervical region. Onset starts within hours of eating
What will you see on physical exam of pt with cholelithiasis normal unless having biliary colic then +murphy sign, severe intermittent cramping pain RUQ, occurs mostly at night, lasts from a few minutes to hours
What is the tx if pt develops acute cholecystitis IV fluids, antibiotics, and analgesics then cholecystectomy should be done within 72hrs
When wouldn't you want to perform a cholecystectomy with acute cholecystitis pt has diffuse peritonitis, acute gallbladder perforation, systemic sepsis, diabetes, patient develops acalculous acute cholecystitis in ICU, or emphysematous cholecystitis
When would you do an open cholecystectomy over laparoscopy if gallbladder is extremely inflamed, infected or has large gallstones
your pt can't be put under general anesthesia and is having acute cholecystitis what can be done for them put in a percutaneous cholecystostomy tube under local anesthesia. Tube can be removed in 6 weeks if it is acalculous
What are gallstones made of cholesterol, bilirubin, calcium, other organic material only 10% are pure cholesterol
What will you see on labs if pt has cholelithiasis normal labs unless obstruction then you get increased alk phos an bilirubin
When would you prefer to use MRCP (magnetic resonance cholangiopancreatography) over ERCP (endoscopic retrograde cholangiopancreatography) Pediatric or Elderly pt, pt with co morbidity, acute pancreatitis, cholangitis. But it may miss low grade strictures and you can get false positives
What are some complications that can arise w/ cholecystitis infection of gallbladder, mirizzi's syndrome (impacted gallbladder stone in cystic duct or neck of g.b.), cholecystoenteric fistula (erosion of stone through g.b wall, acute cholangitis
What treatment can be given to get rid of gall stones without removing gallbladder direct solvent dissolution (methyl tertiary butyl ether), extracorporeal shock wabe lithotripsy (used on big stones >3cm), oral bile salts (ursodiol/chenodial for poor surgical candidates)
This is inflammation of Gallbladder w/o detectable stones and s/sx of biliary colic. Pt presents w/ fever and elevated amylase occurs with trauma, burn patients or immunosuppressed Acalculous Cholecystitis
Who are at increased risk for developing acalculous cholecystitis burn patients on ventilators, immunosuppressed, trauma pt on ventilators
Why is acalculous cholecystitis concerning high mortality rate of 10-50% can be dx with HIDA scan that show gallbladder dyskinesia,
What is the most common cause of acute pancreatitis world wide choledocholithiasis- bile duct stones that have migrated from gallbladder to common bile duct
What is recommended tx for choledocholithiasis stone passes spontaneously in mild cases but cholecystectomy is recommended
This is associated with biliary obstruction and then infection of biliary tree 6-9% of pts with gallstones develop this acute cholangitis
What is Charcot's triad of cholangitis pain, fever, jaundice
What is Reynolds pentad a combination of Charcot's triad w/ two more concerning signs indicating an emergency cholangitis Pain, Fever, Jaundice (Charcot's triad), w/ hypotension and mental confusion
What will you likely see on labs in cholangitis increased serum total bilirubin >2mg , CBC shows leukocytosis, LFT shows elevated AST, cultures may show aerobic and anaerobic gram neg bacteria
What is the tx for cholangitis antibiotic therapy and ERCP with sphincterotomy
What are the common biliary tract neoplasms gallbladder carcinoma, cholangiocarcinoma, adenocarcinoma of ampulla of vater.
what is the tx for neoplasms of gallbladder and biliary tract surgical excision increases 5yr survival rate
Created by: smaxsmith