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Obstructive Jaundice
- 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.
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Cholecystitis
- - 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.
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Cholelithiasis
- - Stones in GB
- - usually asymptomatic & therefore does not req. sx intervention
- - 8-10% of adults have this
Risk Factors:
- - women, multiparous women, postmenopausal women
- - obesity
- - sedentary lifestyle
- - family tendency
- - Native americans, Navajo/Pima
- - less in Asian-Americans and African Americans
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Formation of Gallstones
Cholesterol, bile salts, calcium concentrations determine the precipitation of gallstones
- - prolonged fasting
- - immobility
- - pregnancy delays emptying
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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
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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)
Endoscopic ultrasonography
LFT's NOT USUALLY AFFECTED unless block of common bile duct
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Symptoms of Acute Cholecystitis
Fever
N/V
appears ill
Pain in RUQ, epigastric, or Right scapular area most commonly
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Tx of Acute cholecystitis
NPO
pain control
IV ABX (flagyl q8h + Rocephin 1gm daily)
Lap. Chole. within 24-48hrs of stay
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