becoming a better Clinician
Gallbladder
last updated: December 13, 2016
Orlando Debesa
Cholecystitis
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inflammation of the gallbladder from cystic duct obstruction
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leukocytosis with or without left shift
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elevated aminotransferases
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5-10% acalculous
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most common surgical emergency in the elderly with abdominal pain
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bilirubin will be elevated in cholangitis (will have higher fever and appear more ill than cholecystitis)
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ultrasound is procedure of choice
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nuclear scintigraphy (HIDA scan) most sensitive and specific for cholecystitis
Cholelithiasis
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gallstones in gallbladder
Biliary colic
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pain caused by stone temporarily blocking the cystic duct
Choledocholithiasis
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stone in common bile duct
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usually significant elevation in alkaline phosphatase and transaminases
Cholangitis
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bacterial infection superimposed on an obstruction of the biliary tree (gallstone, neoplasm or stricture)
Porcelain Gallbladder
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uncommon manifestation of chronic cholecystitis
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intramural calcification of the gallbladder wall
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usually asymptomatic but are at increased risk of gallbladder carcinoma (bad prognosis)
Gallbladder volvulus
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rare condition in which there is a rotation of gallbladder around the axis of cystic duct and artery
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observed on patients with significant weight loss, in which there is loss of pericholecystic fat
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complications are related to torsion with vascular compromise and resultant gallbladder ischemia
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US: gallbladder outside the normal anatomical fossa, wall thickening
Risk Factors
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fair: more prevalent in Caucasian population 1
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fat: BMI >30
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female gender
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fertile: one or more children
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forty: age ≥40 -or- familial
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low fiber diet
Charcot's Triad
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fever
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RUQ pain
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jaundice
Reynold's Pentad (Charcot's triad +)
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mental status changes
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hypotension