Test 1 - GI Notes.docx - CHOLELITHIASIS Inflammatory...

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CHOLELITHIASIS Inflammatory, infectious, neoplastic, metabolic, or congenital conditions causing gallstone formation and bile duct obstruction CHOLECYSTITIS is an inflammatory condition that does not involve biliary gallstone obstruction, they will pass, they are not painful or obstructing anything, we do not need to do anything about them. Risk Factors (Gallstones) – female, pregnancy, MATERNAL FAM HX OF GALLSTONES, diet, medications such as estrogen, oral contraceptives, thiazide diuretics, Rapid Weight Loss, gastric bypass, crohns, etoh, hyperparathyroisim. CLINICAL PRESENTATION: Symptomatic Cholelithiasis : Intermittent or steady RUQ abdominal pain that radiates to RIGHT POSTERIOR SHOULDER within an hour of eating a large, high fat meal, may have nausea and vomiting. Charcot Triad: Jaundice, Fever and Abdominal Pain = Stone lodged in Common Bile Duct. Chronic Choleycystitis: RUQ and EPIGASTRIC abdominal pain that radiates to RIGHT POSTERIOR SHOULDER within an hour of eating a large, high fat meal, may have nausea and vomiting. Physical Exam: Acute Cholecystitis will show possible fever and tachycardia due to systemic toxicity, Distended gallbladder, HYPOACTIVE bowel sounds, + Murphy Sign which is an inability to take a deep breath when palpated beneath right costal margin. DIAGNOSTIC: THE DIAGNOSTIC FOR GALLBLADDER IS ULTRASOUND – you can confirm diagnosis with gallbladder thickening and sonagraphic Murphy sign. Hcg is essential for women of childbearing age A rise in Serum Amylase and Lipase = Pancreatitis secondary to vater stone obstrx AST/ALT Transaminases = RISE = prolonged obstruction leading to hepatocellular dstx Plain abdominal radiographs will demonstraete Biliary Air, marked Hepatomegaly and gallstones.
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MANAGEMENT: Tx asymptomatic gallstones with ISOTONIC IV REHYDRATION AND FIX LYTES Patient must be NPO NG Tube for protracted vomiting and to decompress stomach Antispasmodics/Antiemetic meds KETOROLAC TROMETHAMINE is an injectable NSAID to help with pain in
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