Gallbladder disease (main): Difference between revisions

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==DDX==
==Background==
#Cholecystitis
{{Gallbladder disease types}}
#Cholangitis
#Symptomatic Cholelithiasis


{{Gallbladder background}}


==Cholangitis==
==Clinical Features==
===Diagnosis===
*[[RUQ pain]]
# Charcot's Triad: Fever + jaundice + RUQ pain
*Additional features vary by pathology
## 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 ===
==Differential Diagnosis==
# Broad-spectrum parenteral Abx covering gram - and anerobes
{{DDX RUQ}}
## 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===
==Evaluation==
# IV/IM Ketorolac (as effective as meperidine) with Rx for Ibuprofen
*CBC
*Chemistry
*[[LFTs]]
*Lipase
*PT/PTT
*[[Biliary ultrasound]]
 
==Management==
*[[Analgesia]] PRN
*Management varies per specific pathology
 
==Disposition==
*Dependant on pathologic process


==See Also==
==See Also==
[[Ultrasound: Gallbladder]]
*[[Biliary ultrasound]]
*[[Abdominal Pain]]
 
==References==
<references/>


==Source==
==Video==
UpToDate
{{#widget:YouTube|id=OfH7Y-llla4}}


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

Revision as of 16:31, 28 October 2019

Background

Gallbladder disease types

Gallbladder anatomy (overview).
Gallbladder anatomy

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


Video

{{#widget:YouTube|id=OfH7Y-llla4}}