Gallstones: Diagnosis and Management

by Carlo Raj, MD

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    Diagnosis. Right upper quadrant tenderness we talked about, along with this, there’s something called Murphy’s sign. What does that mean? It means that the pain is then going to shoot up into the right scapula for the Murphy’s sign. The gallbladder is usually not palpable. Leukocytosis and elevated liver function test. Now, we’re getting to interesting labs. If in fact it is going to be issues in the biliary tree, what’s the enzyme that you’re paying attention to? Alkaline phosphatase. If you have issues in the liver, you have alk phos and liver function test, such as transaminases elevated. Let me give you another one. What if it was alk phos and lipase? Where is my stone, please? The stone has moved down to the common bile duct. Not only do I have problems with the biliary tree, but I also have damage and pathology to the pancreas. Things that you’re worried about, blood cultures show E.coli. Gram-negative organisms we talked about. Maybe even Clostridium. Imaging. The type of radiology and imaging study that you’d use, ultrasound. The gallstones are symptoms that you would find inside my gallbladder. In addition, remember, if the gallbladder has been obstructed, you can imagine that the gallbladder wall has become inflamed. Therefore, you’d expect to find thickening and edema of the gallbladder wall. In fact, histologically, when the gallbladder has become thickened and cholecystitis continues, at some point in time -- have you heard? I know that you have. In medical school and during your education, you’ve heard of something called porcelain gallbladder. What color is porcelain? White. Gallbladder is not that color normally. So what is then contributing to the whitishness of the gallbladder, the porcelain? The thick wall at some point might start eroding. If you have erosion, there's s a term,...

    About the Lecture

    The lecture Gallstones: Diagnosis and Management by Carlo Raj, MD is from the course Pancreatic and Biliary Tract Diseases.

    Included Quiz Questions

    1. Stone is present at the sphincter of Oddi
    2. Stone is impacted at the cystic duct
    3. Stone is impacted at the left hepatic bile duct
    4. Stone is impacted at right hepatic duct
    5. Stone is impacted at the neck of the gallbladder
    1. Porcelain gall bladder
    2. Gall bladder with gall stone
    3. Acute cholecystitis
    4. Chronic cholecystitis
    5. Cholesterolosis of gall bladder
    1. Abdominal tenderness and pain shooting to the right shoulder
    2. Abdominal tenderness and pain shooting to the left shoulder
    3. Pain when the examiner releases the hand after applying pressure
    4. Abdominal tenderness radiating to the umbilicus
    5. Pain in the abdominal area when legs are extended
    1. Proteus mirabilis
    2. E. coli
    3. Klebsiella
    4. Group D streptococci
    5. Clostridium
    1. Strawberry appearance of the wall of gall bladder
    2. Gall stones
    3. Gall bladder wall thickening
    4. Edema of gall bladder
    5. Dilated biliary tree
    1. HIDA scan
    2. MRCP
    3. ERCP
    4. Repeat Ultrasound scan
    5. X-ray
    1. " Cholecystectomy is done if a person is symptomatic."
    2. " Cholecystectomy cannot be done as an elective procedure."
    3. "Emergency cholecystectomy must be considered for your presentation."
    4. "Cholecystectomy is a futile procedure and the stone will not cause any symptoms in the future."
    5. "Cholecystectomy is a risky and complicated procedure. However, I will perform it with ease on you."
    1. MRCP is the procedure of choice for decompression and sphincterotomy.
    2. Percutaneous drainage is done for acalculous cholecystitis.
    3. Cholecystectomy is avoided in patients who are asymptomatic.
    4. Elective cholecystectomy has significant lower complication rate.
    5. IV antibiotics and hydration are recommended when there is acute cholecystitis.

    Author of lecture Gallstones: Diagnosis and Management

     Carlo Raj, MD

    Carlo Raj, MD

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