Cholelithiasis, Eponyms, and other biliary dx
This is the treatment of choice for the majority of asymptomatic gallstone disease patients.
What is observation?
80% remain symptom-free over the next 15 years.
Antibiotic coverage for acute cholecystitis must include these bacterial categories.
What are gram-negative and anaerobes?
What is presence of gallstones in the common bile duct?
These are 2 of the 4 common gastrointestinal bacterial species listed as causes of acute cholangitis in the ACP slides.
What are:
1) E. Coli
2) Klebsiella
3) Enterobacter
4) Enterococcus
This US finding, reminiscence of fine china or antique dolls, is a high-risk finding concerning for gallbladder cancer.
What is porcelain gallbladder?
This is the initial test of choice to diagnose gallstones (and cholecystitis).
What is abdominal ultrasound?
(CT also super sensitive)
These imaging findings are considered diagnostic for acute cholecystitis if coupled with an appropriate clinical presentation.
What are gallbladder wall thickening, edema/pericholecystic fluid, sonographic Murphy sign, or obstructing stone?
This is the most common presentation of choledocholithiasis.
What is nausea/vomiting and biliary cholic?
Would also accept asymptomatic as <50% of patients develop symptoms.
This triad is only 36% sensitive but 93% specific for diagnosing acute cholangitis.
What is Charcot triad:
1) Jaundice
2) Fever
3) RUQ pain
Geographic risk for this bacterium increases the risk of gallbladder cancer. (Africa, Latin America, and Southeast Asia)
What is Salmonella typhi?
This syndrome is characterized by large gallstones impacting the pylorus of the stomach, leading to gastric outlet obstruction.
What is Bouveret syndrome?
When is before hospital discharge?
This treatment can relieve obstruction in patients with choledocholithiasis.
What is ERCP?
This is the timing for surgical treatment by cholecystectomy of acute cholangitis.
When is within 6 weeks (electively)?
Gallbladder polyps or adenomas > this size are considered a high risk factor for developing gallbladder cancer.
What is 10mm or 1cm?
This syndrome is a complication of pelvic inflammatory disease and is also known as gonococcal or chlamydial perihepatitis.
What is Fitz-Hugh-Curtis syndrome?
This is the next step for diagnosing acute cholecystitis if initial testing is nondiagnositic.
What is cholescintiraphy (HIDA scan)?
This group of patients may present without fever, leukocytosis, or abdominal pain despite other significant evidence of bile duct obstruction.
Who are older patients?
After source control is achieved and the patient is stabile, antibiotics should be continued for this duration of time in patients with acute cholangitis.
How long is four to five days?
This condition, typically seen in middle aged males, is a risk factor for gallbladder cancer
What is primary sclerosing cholangitis?
This syndrome is characterized by an impacted gallstone in the cystic duct, jaundice, and a dilated common hepatic duct caused by extrinsic compression.
What is Mirizzi syndrome?
Often not recognized preoperatively in patients undergoing cholecystectomy and can lead to significant morbidity and biliary injury. MRCP is most sensitive test.
This disease and initial treatment is typically seen in critically ill patients as a result of bile stasis, inflammation/distention, and gallbladder ischemia without evidence of cholelithiasis.
F/u with cholecystectomy vs gallbladder drainage.
This is the egress point of gallstones from the gallbladder in gallstone ileus, which presents with biliary colic, small bowel obstruction, and air in the biliary tree
What is a cholecystoenteric (biliary-enteric) fistula?
These guidelines have a higher sensitivity and specificity than the typical "triad" of findings for diagnosing acute cholangitis.
What are the Tokyo Guidelines?
A) Systemic inflammation (fever, CRP, WBC)
B) Cholestasis (jaundice, ALT/ALP/AST/gGTP x1.5 ULN)
C) Imaging (includes sonographic murphy's)
This rare anatomic variation is a risk factor for developing gallbladder disease.
What is an abnormal pancreaticobiliary duct junction.
More prevalent in Asian populations (especially Japanese!)