#Phase 2.1: Peri Op > Cholecystitis > Flashcards

Cholecystitis Flashcards

(34 cards)

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1
Q

What is cholecystitis?

A

Inflamm of gall bladder, secondary to gall stones

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2
Q

What are the components of bile? (3 things)

A
  1. Cholesterol
  2. Bile pigments (from broken down Hb)
  3. Phospholipids
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3
Q

What causes gall stones to form?

A

Change in concentration of the 3 bile components

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4
Q

How do Pigment stones form?

A

Haemolysis (increased Bile pigments)

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5
Q

What are the characteristics of Pigment stones? (3 things)

A
  1. Small
  2. Irregular
  3. Friable
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6
Q

How do Cholesterol stones form?

A
  1. High cholesterol (obv)
  2. Reduced bile salts
  3. Reduced lecithin

(Admirand’s triangle)

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7
Q

What increases the risk of Cholesterol stones to form?

A
  1. Female
  2. Age
  3. Obesity
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8
Q

What are the characteristics of Cholesterol stones? (2 things)

A
  1. Large

2. Often solitary

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9
Q

What are Mixed stones made up of?

A
  1. Calcium salts
  2. Pigment
  3. Cholesterol
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10
Q

What groups of people are Pigment stones more commonly seen in?

Why

A

Ppl with haemolytic anaemia

Bc increased bile pigment from Hb breakdown

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11
Q

What are cholesterol stones made up of?

A

Purely cholesterol

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12
Q

What are pigment stones made up of?

A

Purely bile pigment

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13
Q

What are the risk factors for gall stones? (5 things)

A
  1. Fat
  2. Female
  3. Fertile
  4. Forty
  5. FHx

5 F’s

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14
Q

What are some other risk factors for gall stones? (4 things)

A
  1. Pregnancy
  2. COCP
  3. Haemolytic anaemia
  4. Malabsorption
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15
Q

How can COCP cause gall stones?

A

Oestrogen causes more cholesterol to be secreted into bile

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16
Q

What are the clinical features of Acute Cholecystitis?

Study These Flashcards
A
  1. Constant RUQ / epigastric pain
  2. Fever
  3. Murphy’s sign @ examination
  4. Guarding = GB perforation
17
Q

Where does the RUQ pain of Acute Cholecystitis refer to?

Study These Flashcards
A

Right shoulder

18
Q

What is the difference in clinical features between biliary colic and Acute Cholecystitis?

Study These Flashcards
A

Inflammatory component (local peritonism / fever / increased WBC)

19
Q

What happens when the gall stones move to the Common Bile Duct (CBD) ?

Study These Flashcards
A
  1. Obstructive jaundice

2. Cholangitis

20
Q

What is Murphy’s Sign?

Study These Flashcards
A
  1. Apply pressure with 2 fingers @ RUQ
  2. Ask patient to inspire
  3. Positive Murphy’s Sign = halt in inspiration bc pain = inflamed GB

Team GB Andy Murray aka Murphy

21
Q

What are other differentials that present with RUQ pain when suspecting Acute Cholecystitis? (4 things)

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A
  1. GORD
  2. Peptic Ulcer Disease (PUD)
  3. Acute Pancreatitis
  4. IBD
22
Q

What lab tests should be done for suspected Acute Cholecystitis?

Study These Flashcards
A
  1. FBC
  2. CRP
  3. LFT
  4. Amylase (or lipase)
  5. Urinalysis (+ pregnancy test if relevant)
23
Q

Why should FBC and CRP be done for suspected Acute Cholecystitis?

Study These Flashcards
A

To assess for presence of inflammatory response

High WBC + CRP

24
Q

Why should LFT’s be done for suspected Acute Cholecystitis? (2 things)

Study These Flashcards
A

High LFT’s (e.g Bilirubin) = Duct occlusion

25
Why should Amylase (or lipase) test be done for suspected Acute Cholecystitis?
To check for evidence of pancreatitis
26
Why should Urinalysis (+ pregnancy test if relevant) be done for suspected Acute Cholecystitis?
To exclude renal / tubo-ovarian pathology
27
What is the first line imaging technique for Acute Cholecystitis?
Trans-abdominal US
28
What can be visualised on an US in Acute Cholecystitis? (4 things)
1. Presence of gallstones / sludge (start of gallstone formation) 2. GB wall thickness (thick = inflamm. likely) 3. Shrunken GB 4. Bile duct dilatation ( = possible stone in distal bile ducts)
29
What scan should be done if US for Acute Cholecystitis is inconclusive? What does it show?
MRCP Shows defects in biliary tree
30
How should a patient with Acute Cholecystitis be managed? (4 things)
1. IV abx (co-amoxiclav +/- metronidazole) 2. Analgesia 3. Anti-emetics 4. Laparoscopic cholecystectomy within 1 week (if fit 4 surgery)
31
How can a patient with Acute Cholecystitis who is not fit for surgery and not responding to abx be managed? Wbat is the down side to this?
Percutaneous cholecystostomy --> drain infection Gall stones still remain inside so still risk of recurring disease
32
What are the complications of Acute Cholecystitis? (4 things)
1. Gangrenous Cholecystitis (20%) 2. Perforation (10%) 3. Gallbladder empyema 4. Cholecystoenteric Fistula (usually seen with Chronic cholecystitis)
33
What does a Cholecystoenteric Fistula result in?
Air in biliary tree (pneumobilia)
34
What happens if a gall stone passes through a Cholecystoenteric Fistula?
Results in gall stone ileus (narrowing??)
#Phase 2.1: Peri Op
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