GASTRO/GENSURG
CHOLECYSTITIS
PromptUS features of cholecystitis
ResponseGB wall >3mm thick/oedema
Pericholecystic fluid/hyperaemia
Sonographic murphies sign
Gallstones - especially if impacted, may be difficult if <5mm or in cystic duct
Pericholecystic fluid/hyperaemia
Sonographic murphies sign
Gallstones - especially if impacted, may be difficult if <5mm or in cystic duct
PromptFalse positive and false negative ultrasound causes
ResponseFalse Positive
Oedematous state (CCF)
Ascites
Localised cancer
Not fasting
False negative
Emphysematous cholecystitis
Air adjacent structures (Eg: Duodenum)
Oedematous state (CCF)
Ascites
Localised cancer
Not fasting
False negative
Emphysematous cholecystitis
Air adjacent structures (Eg: Duodenum)
PromptNormal diameter of CBD
Response<8mm
PromptCauses of extrahepatic biliary obstruction
ResponseCholedocholithiasis
Pancreatic mass
Cholangiocarcinoma
Pancreatic mass
Cholangiocarcinoma
PromptComplications of biliary obstruction
ResponseCholangitis
Reduced absorption of fat soluble vitamins (Most importantly Vit k)
Reduced absorption of fat soluble vitamins (Most importantly Vit k)
PromptComplications postop cholecystectomy that patients might present to ED with
ResponseInjury to biliary tract - bile leak, biliary structure
Bleeding (liver, cystic artery)
Other injury - stomach/duodenum
Chronic diarrhoea (?C Diff from Abx)
Pain - post cholecystectomy syndrome, normal postop pain
Retain stoned - obstructive jaundice/infection
Laparoscopic site infection
Bleeding (liver, cystic artery)
Other injury - stomach/duodenum
Chronic diarrhoea (?C Diff from Abx)
Pain - post cholecystectomy syndrome, normal postop pain
Retain stoned - obstructive jaundice/infection
Laparoscopic site infection