GASTROENTEROLOGY ARTICLE OF THE WEEK
September 4, 2008
Strasberg SM. Acute calculous cholecystitis. N Engl J Med 2008;358:2804-11
1. The hallmark of acute calculous cholecystitis is (choose only one)
a. Thickened gallbladder wall
b. Pain the RUQ
c. Obstructed cystic duct
d. Bilirubin over 8 mg/dL and RUQ pain
e. Cholelithiasis
2. You discover gallstones in a patient while doing an ultrasound because of a history of chronic hepatitis B, the patient wants to know what his risks are of developing symptoms from the stones, you tell him:
a. Over 60%
b. 10 - 15% annually
c. 1 - 4% annually
d. 20 - 35% annually
3. Antibiotic therapy for acute cholecystitis
a. should be initiated as soon as the diagnosis of cholecystitis is made
b. Should include coverage for enterococcus
c. Should be started when diagnosing cholecystitis in a diabetic or elderly patient
d. Should be used prophylactically in patients undergoing cholecystectomy for cholecysitits.
True or False
4. Patiens with asymptomatic gallstones have a 20% chance of developing cholecystitis
5. The inflammatory process in acute cholecystitis is triggered by bacterial infection of the bile
6. A patient who has a gallbladder in situ, but has undergone a sphincterotomy is more likely to have a false positive hepatobiliary scintigraphy.
7. Patients with severe acute cholecystitis should undergo prompt ERCP with sphincterotomy.
8. Bilirubin elevation secondary to acute cholecystitis rarely exceed 4mg/dl
9. Conversion from laparoscopic to open cholecystectomy is more common when the operation is done due to cholecystitis
10. Patients with severe acute cholecystitis are in the greatest need for surgical intervention and should undergo surgery within 4 hours of the diagnosis
11. Acute cholecystitis usually develops in patients with a prior history of symptoms suggestive of biliary colic