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- obstruction of bile duct
- Mostly elevated conjugated bilirubin (direct) but will also cause some increased unconjugated (indirect)
- Feces becomes clay colored due to lack of bilirubin in feces.
- - inflammation of GB
- - usually due to stone blocking GB cystic duct, causing RUQ pain, or referred R subscapular pain.
- can be intermittent after eating, assoc. w/ nausea, then subsiding when stone retracts.
- - Stones in GB
- - usually asymptomatic & therefore does not req. sx intervention
- - 8-10% of adults have this
- - women, multiparous women, postmenopausal women
- - obesity
- - sedentary lifestyle
- - family tendency
- - Native americans, Navajo/Pima
- - less in Asian-Americans and African Americans
Formation of Gallstones
Cholesterol, bile salts, calcium concentrations determine the precipitation of gallstones
- - prolonged fasting
- - immobility
- - pregnancy delays emptying
Symptoms of chronic GB disease
- - intermittent symptoms
- - epigastric or RUQ abd.pain
- - referred pain to scapula/right shoulder
- - tends to occur after eating
- - may be assoc. w/ N/V
Diagnostic testing for chronic GB disease
U/S of GB (20% w/ symptoms will have - test)
HIDA scan (E.F. of GB) (20% w/ symptoms will have - test)
LFT's NOT USUALLY AFFECTED unless block of common bile duct
Symptoms of Acute Cholecystitis
Pain in RUQ, epigastric, or Right scapular area most commonly
Tx of Acute cholecystitis
IV ABX (flagyl q8h + Rocephin 1gm daily)
Lap. Chole. within 24-48hrs of stay
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