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    General Surgery: (Gallbladder Disease)

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    Matt
    The document discusses different gallbladder diseases including gallstones, acute cholecystitis, choledocholithiasis, and ascending cholangitis. It covers the typical presentation, diagnosis, and treatment for each condition. Gallstones are generally asymptomatic but can cause inflammation of the gallbladder or obstruction of bile ducts in more severe cases requiring surgery.

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    General Surgery: (Gallbladder Disease)

    Uploaded by

    Matt
    255 views1 page
    The document discusses different gallbladder diseases including gallstones, acute cholecystitis, choledocholithiasis, and ascending cholangitis. It covers the typical presentation, diagnosis, and treatment for each condition. Gallstones are generally asymptomatic but can cause inflammation of the gallbladder or obstruction of bile ducts in more severe cases requiring surgery.

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    GallBladder

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    The document discusses different gallbladder diseases including gallstones, acute cholecystitis, choledocholithiasis, and ascending cholangitis. It covers the typical presentation, diagnosis, and treatment for each condition. Gallstones are generally asymptomatic but can cause inflammation of the gallbladder or obstruction of bile ducts in more severe cases requiring surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    255 views1 page

    General Surgery: (Gallbladder Disease)

    Uploaded by

    Matt
    The document discusses different gallbladder diseases including gallstones, acute cholecystitis, choledocholithiasis, and ascending cholangitis. It covers the typical presentation, diagnosis, and treatment for each condition. Gallstones are generally asymptomatic but can cause inflammation of the gallbladder or obstruction of bile ducts in more severe cases requiring surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    General Surgery [GALLBLADDER DISEASE]

    Surgery content for this topic is a reduced and simplified version


    of Internal Medicine GI-Gallbladder. It’s present for Surgery-
    Only review (Shelf Studying).

    Gallbladder Means Gallstones


    Except for the obstructive jaundice section, gallbladder
    pathology generally means gallstones. We’re going to talk about
    when stones (cholelithiasis) go bad.
    Normal Anatomy of the Asx Gallstones present,
    Gallstones Hepatobiliary system without obstruction
    Gallstones occur in females who are fat, forty, and fertile (they
    have four or five kids), and fNative American (the F is silent).
    and those who have a hemolytic anemia. Generally,
    asymptomatic gallstones are left alone. Symptomatic
    gallstones present with a colicky RUQ abdominal pain that
    may radiate to the right shoulder and occur after a big fatty
    meal. Symptoms are typically self-limited. An ultrasound Neg Dz Pos Dz
    diagnoses it. An elective cholecystectomy can be done if the
    patient desires. These will convert to Cholecystitis at 2%/yr.
    Acute Cholecystitis. Gallstone HIDA scan. Normal on left has
    Acute Cholecystitis lodges in Cystic Duct, inducing tracer throughout biliary system.
    When a gallstone gets in the cystic duct and stays there an Inflammation of the Gallbladder. Obstruction on right prevents filling
    inflammatory process develops. This causes a constant RUQ No hepatic/pancreatic of the gallbladder. Positive study.
    abdominal pain accompanied by a mild fever and mild involvement involvement
    leukocytosis. It’s often preceded by an episode of cholecystic
    colic. There should be a Murphy's sign. Diagnose with an
    ultrasound to see pericholecystic fluid, a thickened gallbladder
    wall, and gall stones. Equivocal cases can be confirmed with a
    HIDA scan. Urgent cholecystectomy should be performed while
    still in the hospital. Perc drainage is an option.

    Ascending Cholangitis and Choledocholithiasis Choledocholithiasis. Gallstones Pancreatitis.


    If there’s an obstructive jaundice and/or pancreatitis along Obstruction of common duct Obstruction of common duct distal
    with cholecystitis symptoms, there may be a stone in the proximal to pancreatic duct. to pancreatic duct. Biliary, Liver,
    Elevation in Biliary and Liver AND Pancreatic enzymes.
    common duct (choledocholithiasis). MRCP makes the
    enzymes only.
    diagnosis, and ERCP retrieves the stone. Eventually the
    gallbladder needs to come out. Do MRCP first to avoid
    iatrogenic pancreatitis with ERCP. Abx are usually given in case Ascending Cholangitis
    of developing cholangitis. Choledocholithiasis + Infxn Proximal to
    obstruction. Chills, High Fever, Severe
    Leukocytosis
    If, however, there’s a high fever (> 104.1), severe leukocytosis,
    and symptoms of obstructive jaundice without peritoneal Cholangitis:
    findings there’s an infection behind the stone: cholangitis. SKIP 1) RUQ Pain
    the MRCP and start with ERCP (percutaneous drainage is also 2) Fever Charcot’s Triad
    possible, so long as it gets decompressed) Add IV antibiotics to 3) Jaundice
    cover gram negative and anaerobes (cipro + metronidazole). The 4) Hypotension
    5) AMS Reynold’s Pentad
    right answer when considering ascending cholangitis is to start
    antibiotics and do emergent ERCP. Once stable, a
    cholecystectomy is performed.
    Dz Path Pt Dx Tx
    Stones Cholesterol = the “Fs” ASX U/S, Diagnosis not required None
    (“Lithiasis”) Pigmented = Hemolysis
    Cholecystitis Cystic Duct Obstruction RUQ Pain, Murphy’s Sign U/S à HIDA Cholecystectomy
    mild fever , mild leukocytosis (urgent)
    Choledocholithiasis Common Bile Duct Obstruction RUQ Pain, Murphy’s Sign + U/S à MRCP ERCP (urgent),
    (koh-lee-doh-koh) = Hepatitis and/or Pancreatitis ↑AST/↑ALT, ↑Lipase/↑Amylase mild fever, mild leukocytosis Cholecystectomy
    also (elective)
    Ascending All of the above PLUS RUQ Pain, Murphy’s Sign + U/S à MRCPàà ERCP ERCP (emergent)
    Cholangitis Infection behind the stone ↑Labs, T >104, Leukocytosis severe fever and leukocytosis Cholecystectomy
    (urgent)
    © OnlineMedEd. http://www.onlinemeded.org

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