PANCE Blueprint GI and Nutrition (9%)

Biliary Disorders (PEARLS)

The NCCPA™ Gastroenterology and Nutrition PANCE Content Blueprint covers three topics associated with the gallbladder

Acute and chronic cholecystitis Inflammation of the gallbladder; usually associated with gallstones

Presentation:

  • 5 Fs: Female, Fat, Forty, Fertile, Fair
  • (+) Murphy's sign (RUQ pain with GB palpation on inspiration)
  • RUQ pain after a high-fat meal
  • Low-grade fever, leukocytosis, jaundice

Diagnosis:

  • Ultrasound is the preferred initial imaging - gallbladder wall >3 mm, pericholecystic fluid, gallstones
  • HIDA is the best test (Gold Standard) - when ultrasound is inconclusive
  • CT scan - alternative, more sensitive for perforation, abscess, pancreatitis
  • Labs: ↑ Alk-P and ↑ GGT, ↑ conjugated bilirubin
  • Porcelain gallbladder = chronic cholecystitis
  • Choledocholithiasis = stones in common bile duct - diagnosed with ERCP (gold standard)

Treatment: Cholecystectomy (first 24-48 hours)

Cholangitis Acute inflammation of the bile duct characterized by pain in the upper-right quadrant of the abdomen, fever, and jaundice

Organisms: E. coli, Enterococcus, Klebsiella, Enterobacter

Presentation:

  • Charcot’s triad: RUQ tenderness, jaundice, fever
  • Reynold’s pentad: Charcot’s triad + altered mental status and hypotension

Diagnostic studies:

  • Initial imaging: Ultrasound
  • Best: ERCP

Treatment:

Aggressive care and emergent removal of stones, Cipro + metronidazole

  • Antibiotics, fluids, and analgesia.
  • ERCP to remove stones, insert a stent, repair the sphincter
  • Cholecystectomy (performed post-acute)

Primary sclerosing cholangitis

  • Jaundice and pruritus
  • Associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer
Cholelithiasis A precursor to cholecystitis, cholesterol stones account for > 85% of gallstones in the Western world

  • Stones in the gallbladder, pain secondary to contraction of gall against the obstructed cystic duct
  • Asymptomatic (most), symptoms only last few hours
  • Biliary colic—RUQ pain or epigastric
  • Pain after eating and at night
  • Boas sign—referred right subscapular pain
  • RUQ ultrasound - high sensitivity and specificity if  >2 mm. CT scan and MRI

TX: Asymptomatic—No treatment necessary

  • Elective cholecystectomy for recurrent bouts
GI/Nutrition Quick Cram Cards (Prev Lesson)
(Next Lesson) Brian Wallace PA-C Podcast: Diseases of the Gallbladder and Liver
Back to PANCE Blueprint GI and Nutrition (9%)

NCCPA™ Content Blueprint

The Daily PANCE and PANRE

Get 60 days of PANCE and PANRE Multiple Choice Board Review Questions delivered daily to your inbox. It's 100% FREE and 100% Awesome!

You have Successfully Subscribed!