Gallbladder disease (main): Difference between revisions

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==Cholecystitis versus Cholangitis versus Symptomatic Cholelithiasis==
==Background==
{{Gallbladder disease types}}


{{Gallbladder background}}


==Clinical Features==
*[[RUQ pain]]
*Additional features vary by pathology


Acute Cholecystitis==- Diagnosis==
==Differential Diagnosis==
{{DDX RUQ}}


==Evaluation==
*CBC
*Chemistry
*[[LFTs]]
*Lipase
*PT/PTT
*[[Biliary ultrasound]]


* RUQ pain + fever + leukocytosis associated with gallbladder inflammation
==Management==
* Ultrasound
*[[Analgesia]] PRN
* GB wall thickening (greater than 4-5mm) or edema (double wall sign)
*Management varies per specific pathology
* Sonographic Murphy's Sign
==- Treatment ==
 
 
* Antibiotics
* Although clear evidence is lacking, assoc/ w/ decreased wnd infection and bacteremia
* CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)
* Admit
==- Complications ==
 
 
* Gangrene
* Occurs in 20% if untreated (esp. diabetics, elderly, delay in seeking care)
* Consider if pt presents with sepsis in addition to cholecystitis
* Perforation
* Occurs in 2% after development of gangrene 
* Usually localized, leading to pericholecystic abscess
* Gallstone Ileus
* Due to cholecystoenteric fistula
* Emphysematous cholecystitis
* Due to secondary infection of GB by gas-forming organisms
* Presents like cholecystitis (crepitus in abdominal wall may rarely be detected)
* IV abx and cholecystectomy are essential
* Ultrasound report may mistake GB wall gas for bowel gas
 
Cholangitis ==- Diagnosis==
 
 
* Charcot's Triad: Fever + jaundice + RUQ pain
* Occurs in 50-75%
* Reynold's Pentad: The triad + AMS + hypotension
* Hypotension may be the only presenting sign in elderly pts
* Labs
* Leukocytosis with neutrophil predominance
* Elevated alk phos, conj. bilirubin
* Blood culture is indicated
* Imaging
* Ultrasound
* Dilatation of CBD ( > 6mm) and presence of choledocholithiasis
* May miss small CBD stones and in acute cases CBD may not have had time to dilate
* ERCP
* Should be obtained to confirm the diagnosis and to intervene
==- Treatment ==
 
 
* Broad-spectrum parenteral Abx covering gram - and anerobes
* CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)
 
Symptomatic Cholelithiasis==- Diagnosis==
 
 
* History
* RUQ pain that is usually constant, not colicky
* Usually does not occur during fasting
* Physical Exam
* Often benign; as compared to cholecystitis, usually negative Murphy's Sign
* Labs
* LFT, CBC normal
* Ultrasound
* Sensitivity 84%, Specificity 99%
==- Treatment ==
 
 
* IV/IM Ketorolac (as effective as meperidine) with Rx for Ibuprofen
 
Source: UpToDate


==Disposition==
*Dependant on pathologic process


==See Also==
*[[Biliary ultrasound]]
*[[Abdominal Pain]]


==References==
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:Surgery]]

Revision as of 22:07, 27 March 2024

Background

Gallbladder disease types

Gallbladder anatomy (overview).
Gallbladder anatomy
Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.



Anatomy & Pathophysiology

  • Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
  • These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
  • Bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.

Clinical Features

  • RUQ pain
  • Additional features vary by pathology

Differential Diagnosis

RUQ Pain

Evaluation

Management

  • Analgesia PRN
  • Management varies per specific pathology

Disposition

  • Dependant on pathologic process

See Also

References

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