Gallbladder Disorders Overview

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Questions and Answers

Which medication is effective for cholesterol stones in cholelithiasis?

Tenofovir

Ceftriaxone

Sofosbuvir

Ursodeoxycholic acid (correct)

What is an essential monitoring parameter for patients receiving treatment for cholecystitis with ceftriaxone and metronidazole?

White blood cell count

Renal function (correct)

Blood glucose levels

Liver function tests

What is a critical consideration for long-term management in alcoholic liver disease?

Abstinence from alcohol (correct)

Daily exercise regimen

Increased dietary fats

Regular liver biopsies

Which of the following medications is combined with Sofosbuvir for Hepatitis C treatment?

Velpatasvir (C) Signup and view all the answers

What is the primary purpose of vaccination in Hepatitis B management?

To prevent infection (A) Signup and view all the answers

Which Gram-negative bacteria is known to be the most common organism in intra-abdominal infections?

Escherichia coli (A) Signup and view all the answers

What is a major concern regarding the treatment of pancreatitis?

Managing electrolyte imbalances (B) Signup and view all the answers

Which Gram-negative organism is often associated with biliary infections?

Klebsiella species (A) Signup and view all the answers

Which of the following is NOT a risk factor for cholelithiasis?

Chronic hypertension (B) Signup and view all the answers

What is the gold standard for diagnosing gallstones?

Ultrasound (C) Signup and view all the answers

Which treatment option is appropriate for asymptomatic gallstones?

Observation (A) Signup and view all the answers

What indicates the presence of choledocholithiasis?

Elevated AST, ALT, ALP, and bilirubin (B) Signup and view all the answers

What is a common side effect of ursodeoxycholic acid?

Diarrhea (D) Signup and view all the answers

Which clinical feature is associated with cholecystitis?

Persistent RUQ pain (A) Signup and view all the answers

Which of the following is part of Charcot’s triad?

RUQ pain (A) Signup and view all the answers

What is the mechanism of action of ceftriaxone?

Disrupts bacterial cell wall synthesis (D) Signup and view all the answers

What is the primary purpose of administering antibiotics in cases of choledocholithiasis and cholecystitis?

To prevent bacterial colonization and infection. (B) Signup and view all the answers

Which of the following bacteria is most commonly associated with biliary infections?

Escherichia coli (C) Signup and view all the answers

What is a significant risk associated with the use of ceftriaxone in neonates?

Risk of kernicterus (A) Signup and view all the answers

What is the mechanism of action of metronidazole?

Disrupts DNA synthesis in anaerobic bacteria. (D) Signup and view all the answers

Which of the following is a side effect of metronidazole?

Metallic taste (C) Signup and view all the answers

Which antibiotic combination provides coverage for both aerobic and anaerobic bacteria in biliary infections?

Ceftriaxone + Metronidazole (D) Signup and view all the answers

What is the most significant risk of prolonged use of metronidazole?

Peripheral neuropathy (C) Signup and view all the answers

What is the primary mechanism of action of ampicillin?

Inhibits bacterial cell wall synthesis (A) Signup and view all the answers

Which condition is often treated with ERCP as a gold standard procedure?

Choledocholithiasis (D) Signup and view all the answers

Which combination is indicated for synergistic coverage of pathogens in biliary infections?

Ceftriaxone and Metronidazole (B) Signup and view all the answers

What clinical condition is Piperacillin-Tazobactam preferred for?

Severe biliary infections and sepsis (D) Signup and view all the answers

What side effect is specifically associated with Piperacillin-Tazobactam?

Hypokalemia (A) Signup and view all the answers

In what scenario is Ampicillin-Sulbactam indicated?

Moderate-to-severe infections (D) Signup and view all the answers

What is a key monitoring requirement when using Ampicillin?

Renal function (A) Signup and view all the answers

Which bacteria are covered by Piperacillin-Tazobactam?

Bacteroides fragilis (C) Signup and view all the answers

What adverse reaction is a common concern with sulbactam?

Allergic reactions (D) Signup and view all the answers

What is the recommended treatment for penicillin-allergic patients with biliary infections?

Fluoroquinolones + Metronidazole (C) Signup and view all the answers

What duration of antibiotics is typically recommended after achieving source control in biliary infections?

4–7 days (D) Signup and view all the answers

In severe cases of biliary infections, which combination is preferable for treatment?

Piperacillin-Tazobactam or a carbapenem (B) Signup and view all the answers

Which bacteria are commonly associated with diverticulitis?

Bacteroides fragilis and E.coli (D) Signup and view all the answers

What is the first-line outpatient treatment for diverticulitis?

Ciprofloxacin + Metronidazole (A) Signup and view all the answers

Which antibiotic is contraindicated for treating infections caused by EHEC due to the risk of hemolytic-uremic syndrome?

Azithromycin (C) Signup and view all the answers

What is the recommended treatment for mild to moderate Clostridioides difficile infection?

Vancomycin (oral) or Fidaxomicin (A) Signup and view all the answers

Which empirical treatment is suggested for spontaneous bacterial peritonitis?

Ceftriaxone (D) Signup and view all the answers

Which antibiotic is effective against gram-negative organisms such as E.coli and Klebsiella?

Ceftriaxone (D) Signup and view all the answers

What is a common risk associated with fluoroquinolones?

Tendinopathy (B) Signup and view all the answers

For which type of infections is metronidazole particularly used?

Anaerobic infections (C) Signup and view all the answers

What combination should be used for effective coverage in polymicrobial infections?

Piperacillin with Metronidazole (A) Signup and view all the answers

Which patient group is at an increased risk of tendon rupture when using fluoroquinolones?

Older adults on corticosteroids (B) Signup and view all the answers

What should be monitored in high-risk patients using fluoroquinolones?

QT interval (C) Signup and view all the answers

Which antibiotic is preferred for penicillin-allergic patients?

Fluoroquinolones (D) Signup and view all the answers

What is the primary reason for adjusting fluoroquinolone doses in patients?

For renal impairment (A) Signup and view all the answers

What type of coverage does Ampicillin-Sulbactam provide?

Gram-positive and gram-negative organisms (A) Signup and view all the answers

Which side effect is particularly associated with metronidazole?

Metallic taste (D) Signup and view all the answers

Signup and view all the answers

Study Notes

Gallbladder Disorders (Cholelithiasis)

Definition: Formation of gallstones in the gallbladder (cholesterol or pigment stones).
Risk Factors: Five F's (Fat, Fertile, Forty, Female, Flatulent), obesity, rapid weight loss, pregnancy, Crohn's disease, medications (e.g., octreotide, ceftriaxone).
Prevention: Low-carb diet, physical activity, high-fiber diet, NSAIDs, and caffeinated coffee (in females).
Symptoms: Often asymptomatic, but may cause episodic right upper quadrant (RUQ) pain (biliary colic).
Diagnosis: Ultrasound (US) is the gold standard for gallstones.
Treatment:
- Asymptomatic cases: No treatment needed, observation.
- Symptomatic cases: Laparoscopic cholecystectomy.
- Nonsurgical candidates: Ursodeoxycholic acid (bile acid therapy).
Ursodeoxycholic Acid: MOA: Reduces cholesterol saturation in bile; dissolves cholesterol stones. Indications: Non-surgical candidates or prevention of stones (e.g., rapid weight loss patients). Side effects: Diarrhea, pruritus. Clinical Pearls: Most effective for small, non-calcified, cholesterol stones.

Cholecystitis

Definition: Inflammation of the gallbladder, often caused by gallstones (over 90% of cases).
Clinical Features: Persistent RUQ pain, fever, vomiting, Murphy's sign, jaundice in some cases.
Diagnosis: Ultrasound shows gallbladder wall thickening (>5mm), pericholecystic fluid, and Murphy's sign. HIDA scan confirms cystic duct obstruction.
Treatment: NPO, IV fluids, analgesics, broad-spectrum antibiotics (3rd-gen cephalosporins + metronidazole). Antibiotics cover gram-negative and anaerobic bacteria.

Choledocholithiasis

Definition: Gallstones in the common bile duct (CBD).
Clinical Features: RUQ colicky pain, fever, jaundice (Charcot's triad). Altered mental status and hypotension (Reynolds' pentad): suspect acute suppurative cholangitis.
Diagnosis: Elevated AST, ALT, ALP, and bilirubin. Imaging: Ultrasound, ERCP (gold standard for diagnosis and treatment).
Treatment: ERCP for stone removal, stent placement. Antibiotics: Fluoroquinolone, ampicillin, gentamicin + metronidazole. Cholecystectomy.

Antibiotics in Choledocholithiasis and Cholecystitis

Crucial for controlling secondary infections.
Common bacteria include Gram-negative rods (e.g., E. coli, Klebsiella).
Important anaerobes include Bacteroides fragilis.

Monitoring and Follow-Up

Resolution of fever, leukocytosis, and abdominal symptoms.
Repeat imaging if no improvement within 48-72 hours.
Monitor for persistent abscesses or new infections.
In severe cases, assess for multi-system organ failure.
Utilize narrow-spectrum antibiotics after culture results are available.
Refrain from unnecessarily prolonged antibiotic use.

Alcoholic Liver Disease

Pathophysiology: Alcohol metabolites cause direct liver injury, activate Kupffer cells, trigger inflammatory pathways, and oxidative stress, leading to hepatocyte damage, cholestasis, and potential progression to liver failure.
Symptoms: Jaundice, hepatomegaly, anorexia, ascites, encephalopathy.
Labs: Elevated AST > ALT (2:1 ratio), alkaline phosphatase, bilirubin, macrocytic anemia.
Treatment: Abstinence, medications for alcohol use disorder (e.g., naltrexone), corticosteroids in severe cases (e.g., prednisolone). Nutritional support (thiamine, folate, zinc) may be critical.

Viral Hepatitis

Hepatitis A: Fecal-oral route, acute infection. Diagnosis: IgM anti-HAV (acute), IgG anti-HAV (immunity). Treatment: Supportive care, vaccination for high-risk groups.
Hepatitis B: Blood, body fluids. Chronic infection risks: Cirrhosis, liver cancer. Prevention: Vaccination.
Hepatitis C: Bloodborne (e.g., IV drug use). Prevention: Screening for high-risk groups. Treatment: Direct-Acting Antivirals (DAAs); high cure rates.

Cirrhosis

Definition: Irreversible liver fibrosis and nodular regeneration.
Symptoms: Early: Fatigue, weight loss, nausea. Late: Ascites, encephalopathy, spider nevi, palmar erythema.
Treatment: Manage complications (ascites, encephalopathy). Definitive treatment: Liver transplant.

Acute Pancreatitis

Definition: Inflammation of the pancreas.
Causes: Gallstones, alcohol abuse, hyperlipidemia, medications..
Symptoms: Severe epigastric pain radiating to the back, nausea, vomiting.
Diagnosis: Labs: Elevated amylase, lipase. Imaging: US or CT. Treatment: Supportive care, IV fluids. Pain relief (Morphine)
Antibiotic therapy: reserved for infected necrosis

Chronic Pancreatitis

Definition: Chronic inflammation causing irreversible pancreatic damage.
Symptoms: Chronic abdominal pain, malabsorption, steatorrhea, diabetes.
Treatment: Pain management, pancreatic enzyme replacement, address underlying causes (e.g., stop alcohol abuse), and maintain quality of life.

Diverticulitis, Infectious Diarrhea, Clostridioides difficile Infection, Spontaneous Bacterial Peritonitis, Appendicitis, and Liver Abscesses.
Treatment based on bacterial infection type. Consider ceftriaxone, metronidazole, or piperacillin-tazobactam.

Other

General considerations for antibiotic selection and treatment.

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Description

This quiz covers critical aspects of gallbladder disorders, specifically cholelithiasis. It includes definitions, risk factors, prevention strategies, symptoms, diagnosis, and treatment options for gallstones. Test your knowledge on this important health topic!