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
Diagnosis:
- Ultrasound is the preferred initial imaging
- Gallbladder wall >3 mm, pericholecystic fluid, gallstones
- HIDA is the best test (Gold Standard)
- porcelain gallbladder = chronic cholecystitis
Treatment: Cholecystectomy |
| 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 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 |
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