Quartz 5

Chole

Properties1
aliases—

2 min read

quick reference

Cholecystitis

  • Sx: colicky RUQ pain, steadily increasing RUQ or epigastric pain after eating fatty foods, fever
  • PE: Murphy sign, Boas sign (hyperaesthesia, increased or altered sensitivity, below the right scapula)
  • Diagnosis
    • Initial: U/S
    • Gold standard: HIDA
  • Most commonly caused by obstruction by a gallstone
  • Acalculous disease can occur when critically ill
  • Treatment is cholecystectomy, antibiotics, and percutaneous cholecystostomy tube when critically ill or if have comorbidities and do not improve on antibiotics

Cholangitis

Infectious
(less commonly cholecystitis): Charcot’s Triad / Reynold’s Pentad
- RUQ pain
- Fever
- Jaundice
- Hypotension
- AMS

R factor score = points towards cholestatic vs. hepatocellular vs mixed injury

Autoimmune
Primary Biliary Cholangitis

pathophysiology

Chole- words are confusing

Cholecystitis
-Gallbladder inflammation caused by cystic duct blockage

  • <6 hours, colicky pain = cholecystitis
  • Calculous cholecystitis = most common (95%)
    • pain >6hrs or stone identified on imaging
    • Stone in cystic duct: cholelithiasis
      • Mirizzi syndrome: stone in cystic duct obstructs hepatic duct
    • Stone in common bile duct: Choledocholithiasis
  • Acalculous cholecystitis

Cholangitis

epidemiology / etiology

Cholecystitis signs on CT:

  1. Dilation (>4cm x 9cm)
  2. Wall thickening (>3mm)
  3. Pericholecystic fluid
  4. Fat stranding
  5. Gallstones

clinical features

Physical Exam

  • Pos murphy sign

  • biliary colic

  • radiate to R shoulder

  • ALP > 3xIULN

  • Elevated Tbili

  • Positive Murphy

  • Dark Urine

Double duct sign: dilation of CBD and Pancreatic duct

  • Malignant until proven otherwise
  • MC: Pancreatic cancer (HOP mass, ampullary tumor, cholangiocarcinoma)

diagnosis

treatment

other

About 95% of people with acute cholecystitis have gallstones. 6(https://www.ncbi.nlm.nih.gov/books/NBK459171/#) However that does not mean incidental findings of gallstone should be treated, as it is estimated that only 20% of patients with asymptomatic stones will develop symptoms within 20 years7(https://www.ncbi.nlm.nih.gov/books/NBK459171/#), and because approximately 1% of patients with asymptomatic stones develop complications of their stones before the onset of symptoms, prophylactic cholecystectomy is not warranted in asymptomatic patients.

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