Surgical Conditions of the Gallbladder – USMLE Exams

by / Saturday, 19 June 2010 / Published in Surgery

Gallstones (Cholelithiasis)

Seen mostly in women with the 4 F’s

  1. Female
  2. Fat
  3. Forty
  4. Fertile

 

  • It isn’t the presence of gallstones that warrants intervention, but the possible complications associated with them
  • Ultrasound is the test of choice for identifying gallstones

 

Treatment:

  • Asymptomatic gallstones require no intervention
  • Chronic pain may require a cholecystectomy
  • With an increased risk of cancer, such as in the case of a calcified gallbladder wall, cholecystectomy may be warranted

 

Cholecystitis

  • Is an infection of the gallbladder that is a result of an obstruction
  • Common causes are: E. Coli, Enterobacter, Enterococcus, and Klebsiella

Note the shadow from the impacted stone.

Signs and Symptoms:

  • Acute onset of right upper quadrant pain that is non-remitting
  • (+) Murphy’s sign – arrest of inspiration upon palpation

Diagnosis:

  • Ultrasound to detect stones, a thickened wall, or fluid surrounding the GB
  • Confirm with HIDA scan
  • Labs show WBC’s >20,000, Ý Bilirubin, Ý AST/ALT

 

Treatment:

  • Keep patient NPO, give IV fluids, and give antibiotics to cover gram (-) rods and anaerobes
  • Do not give morphine for pain because it causes a spasm of the sphincter of oddi
  • If improvements are not seen, cholecystectomy may be warranted

 

Ascending Cholangitis

  • Obstructed bile flow from an obstructed common bile duct leads to an infection
  • Presence of Charcot’s triad:  RUQ, fever, jaundice is commonly seen

 

Diagnosis:

  • Ultrasound to detect dilation
  • An ERCP can be used after the preliminary US diagnosis

Treatment:

  • NPO
  • IV fluids
  • Gram (-) antibiotics
  • ERCP for decompression of the biliary tree and for removal of the stones

 


Choledocholithiasis

  • An obstruction of the common bile duct

Signs and Symptoms:

  • Jaundice (obstructive)
  • Ý Alkaline phosphatase
  • Ý Conjugated bilirubin

Diagnosis:

  • Ultrasound to detect CBD obstruction

 

Treatment:

  • Cholecystectomy

 

Cancer of the GB


  • Is a rare cancer that is associated with a history of gallstones
  • Occurs later in life
  • The MC primary tumor of the gallbladder is the adenocarcinoma
  • Associated with Clonorchis sinensis infestation
  • Has a grave prognosis, with most patients dying within 1yr of diagnosis

 

Signs and Symptoms:

  • Sharp, colicky pain

Diagnosis:

  • US or CT to detect the tumor

Treatment:

  • Placement of bile duct stents
  • Surgery as a palliative option, but is not curative

4 Responses to “Surgical Conditions of the Gallbladder – USMLE Exams”

  1. Very good post.Really thank you! Awesome.

  2. Lise Grit says : Reply

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    • Dr. Paul Ciurysek, M.D. says : Reply

      Lisa,

      Thank you so much what a wonderful comment! Highly appreciated!

      Paul

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