Gallbladder disease (main): Difference between revisions

Latest revision as of 22:07, 27 March 2024

Background

Gallbladder disease types

Gallbladder anatomy (overview).

Gallbladder anatomy

Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.

Symptomatic cholelithiasis (biliary colic)
Choledocholithiasis
Acute calculous cholecystitis
Ascending cholangitis
Acalculous cholecystitis
Biliary atresia
Cholestasis of pregnancy

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

Gallbladder disease
- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Acute cholecystitis
- Ascending cholangitis
- Acalculous cholecystitis
Pancreatitis
Acute hepatitis
Pancreatitis
GERD
Appendicitis (retrocecal)
Pyogenic liver abscess
Bowel obstruction
Cirrhosis
Budd-Chiari syndrome
GU
Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm

Evaluation

CBC
Chemistry
LFTs
Lipase
PT/PTT
Biliary ultrasound

Management

Analgesia PRN
Management varies per specific pathology

Disposition

Dependant on pathologic process

References

Authors:

@@ Line 1: / Line 1: @@
-==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==
-[[Ultrasound: Gallbladder]]
+*[[Biliary ultrasound]]
+*[[Abdominal Pain]]
-==Source==
+==References==
-UpToDate
+<references/>
 [[Category:GI]]
+[[Category:Surgery]]