https://wikem.org/w/api.php?action=feedcontributions&feedformat=atom&user=N8henrie 2026-05-13T06:37:52Z User contributions MediaWiki 1.38.2 https://wikem.org/w/index.php?title=User:N8henrie&diff=12415 2013-08-27T19:44:25Z

<p>N8henrie: </p> <hr /> <div>Nathan Henrie MD.<br /> <br /> HO1, Emergency Medicine, University of New Mexico Hospital<br /> http://n8henrie.com</div>

N8henrie https://wikem.org/w/index.php?title=Acute_calculous_cholecystitis&diff=10350 2012-08-14T21:21:08Z

<p>N8henrie: /* Complications */</p> <hr /> <div>==Clinical Features==<br /> *Upper abdominal pain (esp RUQ)<br /> **Not necessarily related to meals or fatty food intolerance<br /> *N/V, fever<br /> <br /> ==Diagnosis==<br /> #Local Signs<br /> ##RUQ tenderness<br /> ##Murphy Sign<br /> ###Highest positive LR of any clinical finding or lab value<br /> #Sysemtic signs<br /> ##Fever<br /> ##Leukocytosis<br /> #Imaging<br /> ##[[Ultrasound: Gallbladder]]<br /> ###GB wall thickening (&gt;3mm)<br /> ####May also be seen w/ pancreatitis, ascites, heart failure, alcoholic hepatitis<br /> ###Pericholecystic fluid<br /> ###Sonographic Murphy's Sign (PPV 92%)<br /> ####May be absent in pts w/ DM, gangrenous cholecystitis<br /> ##CT<br /> ###Useful when US results are equivocal<br /> <br /> ==Treatment==<br /> #Antibiotics<br /> ##Although clear evidence is lacking, assoc/ w/ decreased wnd infection and bacteremia<br /> ##Cefotaxime + metronidazole OR piperacillin/tazobactam OR ampicillin-sulbactam<br /> ###Bacteria: Gm negative (75%), gm positive (15%), anaerobes (8%)<br /> <br /> ==Disposition==<br /> *Admit<br /> <br /> ==Complications==<br /> #Gangrene<br /> ##Occurs in 20% if untreated (esp. diabetics, elderly, delay in seeking care)<br /> ##Consider if pt presents with sepsis in addition to cholecystitis<br /> #Perforation<br /> ##Occurs in 2% after development of gangrene <br /> ##Usually localized, leading to pericholecystic abscess<br /> #Gallstone Ileus<br /> ##Due to cholecystoenteric fistula<br /> #Emphysematous cholecystitis<br /> ##Due to secondary infection of GB by gas-forming organisms (C. perfringens)<br /> ##Presents like cholecystitis but often progresses to sepsis and gangrene<br /> ##IV abx and cholecystectomy are essential<br /> ##Ultrasound report may mistake GB wall gas for bowel gas <br /> ##Mortality as high as 15% due to gangrene or perforation<br /> #Mirizzi Syndrome<br /> ##Partial obstruction of common hepatic duct due to stone impaction / chronic inflammation<br /> ##Symptoms of acute cholecystitis + dilated intrahepatic ducts + jaundice<br /> ##Inflammation can cause erosive fistula from Hartmann pouch into common hepatic duct<br /> ###US and CT can usually delineate the fistula<br /> ##Treatment = open cholecystectomy<br /> #Gallstone Ileus<br /> ##Bowel obstruction due to impaction of gallstone at terminal ileum<br /> ###Gallstone enters small bowel through biliary-duodenal fistula<br /> ##Diagnosis suggested by pneumobilia, bowel obstruction, ectopic gallstone<br /> <br /> ==See Also==<br /> *[[Gallbladder Disease (Main)]]<br /> *[[Cholangitis]]<br /> *[[Symptomatic Cholelithiasis]]<br /> <br /> ==Source==<br /> *UpToDate<br /> *Tintinalli<br /> <br /> [[Category:GI]]<br /> [[Category:ID]]</div>

N8henrie https://wikem.org/w/index.php?title=Acute_calculous_cholecystitis&diff=10349 2012-08-14T21:20:37Z

<p>N8henrie: /* Treatment */</p> <hr /> <div>==Clinical Features==<br /> *Upper abdominal pain (esp RUQ)<br /> **Not necessarily related to meals or fatty food intolerance<br /> *N/V, fever<br /> <br /> ==Diagnosis==<br /> #Local Signs<br /> ##RUQ tenderness<br /> ##Murphy Sign<br /> ###Highest positive LR of any clinical finding or lab value<br /> #Sysemtic signs<br /> ##Fever<br /> ##Leukocytosis<br /> #Imaging<br /> ##[[Ultrasound: Gallbladder]]<br /> ###GB wall thickening (&gt;3mm)<br /> ####May also be seen w/ pancreatitis, ascites, heart failure, alcoholic hepatitis<br /> ###Pericholecystic fluid<br /> ###Sonographic Murphy's Sign (PPV 92%)<br /> ####May be absent in pts w/ DM, gangrenous cholecystitis<br /> ##CT<br /> ###Useful when US results are equivocal<br /> <br /> ==Treatment==<br /> #Antibiotics<br /> ##Although clear evidence is lacking, assoc/ w/ decreased wnd infection and bacteremia<br /> ##Cefotaxime + metronidazole OR piperacillin/tazobactam OR ampicillin-sulbactam<br /> ###Bacteria: Gm negative (75%), gm positive (15%), anaerobes (8%)<br /> <br /> ==Disposition==<br /> *Admit<br /> <br /> ==Complications==<br /> #Gangrene<br /> ##Occurs in 20% if untreated (esp. diabetics, elderly, delay in seeking care)<br /> ##Consider if pt presents with sepsis in addition to cholecystitis<br /> #Perforation<br /> ##Occurs in 2% after development of gangrene <br /> ##Usually localized, leading to pericholecystic abscess<br /> #Gallstone Ileus<br /> ##Due to cholecystoenteric fistula<br /> #Emphysematous cholecystitis<br /> ##Due to secondary infection of GB by gas-forming organisms (C. perfringens)<br /> ##Presents like cholecystitis but often progresses to sepsis and gangrene<br /> ##IV abx and cholecystectomy are essential<br /> ##Ultrasound report may mistake GB wall gas for bowel gas <br /> ##Mortality as high as 15% due to gangrene or perforation<br /> #Mirizzi Syndrome<br /> ##Partial obstruction of common hepatic duct due to stone impaction / chronic inflammation<br /> ##Symptoms of acute cholecystitis + dilated intrahepatic ducts + jaundice<br /> ##Inflammation can cause erosive fistula from Hartmann pouch into common hepatic duct<br /> ###US and CT can usually delineate the fistula<br /> ##Treatment = open cholecystectomy<br /> #Gallstone Ileus<br /> ##Bowel obstruction due to impactio nof gallstone at terminal ileum<br /> ###Gallstone enters small bowel through biliary-duodenal fistula<br /> ##Diagnosis suggested by pneumobilia, bowel obstruction, ectopic gallstone<br /> <br /> ==See Also==<br /> *[[Gallbladder Disease (Main)]]<br /> *[[Cholangitis]]<br /> *[[Symptomatic Cholelithiasis]]<br /> <br /> ==Source==<br /> *UpToDate<br /> *Tintinalli<br /> <br /> [[Category:GI]]<br /> [[Category:ID]]</div>

N8henrie