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Gallbladder (Choledocholithiasis (Pt: Px obstructive jaundice (Murphy sign…

- - - - elevated amylase and lipase
      - bile continues to be created, causing dilation of the duct
        
        acutely, not that big, but larger than normal, eventually leading to jandice
  - - - may have pancreatitis
        
        DX: RUQ US
        
        looking for dilated ducts (wont see stone, too small)
        
        No dilated ducts, stone may not be there
        
        :green_cross:eg US but still suspect
        
        MRCP
        
        1 more item...
- - - - Then Urgent cholecystectomy
    - - ABX: Cipro :sunflower: & Metro :bullettrain_side:
        
        Older: AG & Metro
      - :warning:WRONG: Pip/tazo
        expensive, everyone uses, will cover gram neg and anaerobes, wasting Pseudomonas treatment and overcovering for strep
- - - - 5 F's
        
        Fat
        
        Female
        
        Forty (40)
        
        Fertile
        
        Native American
      - Pigmented stones- hemolysis (BLACK)
    - - Gallbladder contracts against a stone causing px
      - Pt: Colicky abn pain in RUQ radiating to shoulder, worse with fatty foods
        
        fatty foods cause more contraction of the gallbladder
        
        DX: RUQ U/S shows gallstone
        
        :pencil2:US is great because of contrast btw liver and gallbladder
        
        TX: Cholesystectomy (elective)
        
        else Ursodeoxycholic acid (non-sx)
- - - - DX: RUQ US (3 items are enough for dx)
        
        Gallstones
        
        Thickened Gallbladder wall
        
        Pericholesystic fluid
        
        :green_cross::green_cross::green_cross:Not all (+)?
        
        HIDA SCAN
        tracer fills biliary tree BUT not the gallbladder
        
        1 more item...