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


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


  • 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


  • 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


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
GI/Nutrition Quick Cram Cards (Prev Lesson)
(Next Lesson) Brian Wallace PA-C Podcast: Diseases of the Gallbladder and Liver
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NCCPA™ Content Blueprint

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