Chapter 37

Question 1

CHRONIC CHOLELITHIASIS
-What does Cholelithiasis mean?

Answer 1

Formation of cholesterol stones in the gallbladder

Question 2

CHRONIC CHOLELITHIASIS
-What is the chief complaint of chronic cholelithiasis?
-Describe what it means

Answer 2

-Intermittent biliary colic
-Persistent epigastric or right upper abdominal pain

Question 3

CHRONIC CHOLELITHIASIS
-This is typically caused by what?

Answer 3

Intermittent obstruction of cystic duct by a gallstone

Question 4

CHRONIC CHOLELITHIASIS
-Symptoms may be precipitated by what?
-What kind of schedule does this recur on?
-How does it occur?
-When may it manifest?

Answer 4

-a meal
-frequent or infrequent
-spontaneously
-at night

Question 5

CHRONIC CHOLELITHIASIS
-Describe pain onset & duration

Answer 5

1. Pain INCREASES steadily for >15 minutes
2. Lasts several hours
3. Then slowly DECREASES

Question 6

CHRONIC CHOLELITHIASIS: S/S
-What is a way to remember what occurs with this?
-What does it stand for?

Answer 6

Never Bring Fatty Eagles
Nausea, vomiting, sweating
Belching, flatus (gas), bloating
Fatty food intolerance
Epigastric burning

Question 7

CHRONIC CHOLELITHIASIS: Diagnosis
-How is this diagnosed?

Answer 7

Ultrasound

Question 8

CHRONIC CHOLELITHIASIS: Treatment
-How is this treated? (4)

Answer 8

1. Watchful waiting
2. Cholecystectomy
3. Chemical dissolution of gallstones
4. Lithotripsy

Question 9

CHRONIC CHOLELITHIASIS: Treatment
-What is Cholecystectomy?

Answer 9

Surgical removal of the gallbladder

Question 10

CHRONIC CHOLELITHIASIS: Treatment
-What is lithotripsy?

Answer 10

Mechanical breaking up of gallstones within the gallbladder

Question 11

ACUTE CHOLECYSTITIS
-What is this?

Answer 11

Acute inflammation of the gallbladder wall

Question 12

ACUTE CHOLECYSTITIS
-What is it characterized by?

Answer 12

Severe right upper abdominal pain that radiates to the back

Question 13

ACUTE CHOLECYSTITIS: Etiology
-____ is present in 90% of patients
-What MAY be present?

Answer 13

-Cholelithiasis
-Bacterial infection

Question 14

ACUTE CHOLECYSTITIS: Etiology
-What occurs in ALMOST ALL patients?
-This means that it is related to what?

Answer 14

-Obstruction of cystic duct
-Stasis of bile

Question 15

ACUTE CHOLECYSTITIS
-What happens if this is left untreated?
-What can this lead to?

Answer 15

-The inflammatory process ESCALATES & gangrene of the gallbladder wall with rupture may occur

1. Peritonitis
2. Septic shock
3. Localized abcess (empyema)
4. Cholecystoenteric fistula

Question 16

ACUTE CHOLECYSTITIS
-What is cholecystoenteric fistula?

Answer 16

Fistula between gallbladder & GI tract

Question 17

ACUTE CHOLECYSTITIS: Clinical Manifestations
-What is a way to remember this and what does it stand for?

Answer 17

All Foxes Like Milk
Abdominal tenderness
Fever
Leukocytosis
Mild elevations of bilirubin & serum transaminases

Question 18

ACUTE CHOLECYSTITIS: Diagnosis
-What is used?

Answer 18

1. Abdominal ultrasound
2. Imaging

Question 19

ACUTE CHOLECYSTITIS: Diagnosis
-What 3 kinds of imaging are used?

Answer 19

1. HIDA scan
2. Computed tomography (CT)
3. Endoscopic retrograde cholangiopancreatography (ERCP)

Question 20

ACUTE CHOLECYSTITIS: Treatment
-What is the MAINSTAY of therapy for acute cholecystitis?

Answer 20

Laparoscopic cholecystectomy

Question 21

ACUTE CHOLECYSTITIS: Treatment
-If there is a bacterial infection, what is used to treat it?

Answer 21

Antibiotics

Question 22

ACUTE CHOLECYSTITIS: Treatment
-What is used to treat obstruction?

Answer 22

Percutaneous catheter drainage OR endoscopic drainage with stent placement

Question 23

ACUTE CHOLECYSTITIS: Treatment
-What are considered surgical emergencies?

Answer 23

-Gangrene
-Empyema
-Emphysematous changes

Question 24

ACUTE CHOLECYSTITIS: Treatment
-What kind of management is important?

Answer 24

Pain management

Question 25

**ACUTE CHOLECYSTITIS**: *Treatment* -What are two nonsurgical treatments used?

Answer 25

1. Chemodissolution 2. Lithotripsy

Question 26

**ACUTE CHOLECYSTITIS**: *Treatment* -What is Chemodissolution?

Answer 26

Use of bile acids/organic solventts to dissolve gallstone

Question 27

**ACUTE CHOLECYSTITIS**: *Treatment* -What is lithotripsy? -It is only used for..

Answer 27

-Breaking up of gallstones using shockwaves -stones <2 cm

Question 28

What is a subgroup of Acute Cholecystitis?

Answer 28

Acalculous Cholecystitis

Question 29

**ACALCULOUS CHOLECYSTITIS** -Who does this occur in?

Answer 29

-Patients WITHOUT preexisting gallstones -Males >50 years

Question 30

**ACALCULOUS CHOLECYSTITIS** -It tends to occur in the setting of... (5)

Answer 30

1. Major surgery 2. Critical illness 3. Trauma 4. Burn-related injury 5. Total parenteral nutrition (TPN)

Question 31

**ACALCULOUS CHOLECYSTITIS** -There is a rapid development of what? (4)

Answer 31

Gagrene, perforation, emphysematous cholecystitis, empyema