Luokat: Kaikki - treatment - medications - imaging - surgery

jonka Kelsey Tieken 7 kuukautta sitten

182

Cholecystitis

Cholecystitis is a condition that requires comprehensive assessment through physical exams, patient history, and various diagnostic tests, including imaging and lab work. Imaging techniques like HIDA scans, CT scans, and ultrasounds help identify specific features such as gallbladder wall thickening and the presence of stones or sludge.

Cholecystitis

Cholecystitis

Differential Diagnosis

gallstone ileus
gallstone pancreatitis
cholangitis
choledocholithiasis
cholecystitis
Biliary dyskinesia
Gallbladder ejection fraction

See HIDA scan

Biliary colic
asymptomatic
symptomatic

Symptoms

Fever
objective

temp >38.5C

subjective

diaphoresis

chills

Jaundice
skin yellowing
icterus
Right shoulder/back
Right upper quadrant

constant

colicky

Post-prandial
Bloating
Vomiting
Nausea
Asymptomatic

Treatment

Cholecystostomy tube
cannot tolerate anesthesia

cardiac function

pulmonary reserve

critically ill

need for blood pressure support

epinephrine

vasopressin

norepinephrine

mechanically ventilated

Surgery
Laparoscopic Cholecystectomy

decrease post-op pain

shorter recovery

Small incisions

Open cholecystectomy

increased post-op pain

longer recovery time

Right subcostal incision

Antibiotics!

anaerobes

Gram negatives

Physical Exam

Imaging
HIDA

used when other findings equivocal

Gold Standard

absence of gallbladder filling @ 60 minutes

Ejection fraction

radionucleotide scan

Ultrasound

Sonographic Murphy's sign (U/S Only)

CBD Diameter

Stones/Sludge

Pericholecystic fluid

GB wall thickening

CT scan
Labs
Urine pregnancy

Female of childbearing age

Lactic acid

resuscitation adequacy

R/O sepsis

Amylase/Lipase

R/O other pathology

CMP

Liver function

hyperbilirubinemia?

Electrolytes

CBC

Leukocytosis

Physical Exam
Abdomen

Surgical Scars

Murphy's Sign

RUQ Tenderness

Lungs
Heart
History
Allergies
Medications

Chronic steroid use

Chronic Opioids

Beta Blockers

Anticoagulation

Surgical History
Medical History

Pulmonary Fxn

Cardiac Fxn

Pain

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