3. GOLD STANDARD TEST FOR CHOLECYSTITIS

GI (NCCPA outline) (Latest / Answers 100% Correct

• - Patient will be an overweight (Fat),Fertile,Female in her Forties (4Fs)
• Complaining of colicky, steadily increasing RUQ or epigastric pain after eating fatty foods
• PE will show *Murphy's sign, Boas sign*

Diagnosis is made by:

-- Initial = US -- Gold standard = HIDA

• Most commonly caused by obstruction by a gallstone
• Treatment is cholecystectomy

Answer: Cholecystitis

• Initial test for Cholecystitis?

Answer: U/S

3. GOLD STANDARD TEST FOR CHOLECYSTITIS

Answer: HIDA scan aka Cholescintography

• - is due to *infection* of the biliary tract
• It may present similarly to cholecystitis, but is also associated with *in- creased bilirubin

leading to jaundice*

• characterized by *Charcot's triad* (right upper quadrant pain + jaundice
• fever) and *Reynold's pentad* (Charcot's triad + shock + mental status changes).

Answer: Cholangitis

• What is Charcot triad?

Answer:

• RUQ pain
• Jaunice
• Fever

• What is Reynold's pentad?

Answer: Charcots (RUQ PAIN, JAUNDICE, FEVER)

+ SHOCK

• AMS

• For patients presenting with symptoms highly suggestive of gallstones but without

gallstones on imaging, a should be per- formed. 1 / 2

Answer: cholecystokinin-HIDA scan

• Cholecystokinin-HIDA scan, is a variant of the hepatobiliary iminodiacetic (HIDA) scan and

can be used in the elective setting to assess gallbladder contractility and calculate an ejection fraction

• - Patient will be an obese woman 40-50yo
• Complaining of slowly resolving right upper quadrant pain that begins suddenly after eating

a fatty or large meal

• Diagnosis is made by ultrasound
• Most commonly made of cholesterol

• Treatment is observation or cholecystectomy

Answer: Cholelithiasis/Choledocholithiasis

• - Patient with a history of dysrhythmias (AF), recent MI, or CAD
• Complaining of abdominal pain out of proportion to exam
• Labs will show lactic acidosis
• Diagnosis is made by CTA, angiography (gold standard)

Answer: Mesenteric Ischemia

• What blood vessel is most commonly affected in mesenteric arterial embolism?

Answer: The superior mesenteric artery (SMA) is the most common site of arterial emoblism.

• What is BOAS sign

Answer: Referred right subscapular pain of biliary colic

• - Patient will have a history of chronic liver disease or cirrhosis
• Complaining of fever, chills, and abdominal pain
• PE will show ascites, shifting dullness
• Labs will show PMNs > 250, WBC > 1,000, pH < 7.34
• Diagnosis is made by analysis of the ascitic fluid
• Most commonly caused by E. coli, Streptococcus spp
• Treatment is immediate IV antibiotics (third-generation cephalosporin). Con- sider giving

albumin

Answer: Spontaneous Bacterial Peritonitis

• inflammation of Glisson's capsule, which surrounds the liver, and is a complication of

pelvic inflammatory disease. It often presents as right upper quadrant tenderness and pain concurrent with signs and symptoms of pelvic inflammatory disease.

Answer: Periphepatitis

Fitz Hugh Curtis Syndrome

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