Cholecystitis

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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

OLD CARTS