Step I GI confusions

[sweatybrain]

Can someone explain to me the differences (both in the pathogenesis and presenting signs/symptoms) among acute and chronic cholecystitis, biliary cholic, choledocholithiasis, and cholelithiasis?

 

[RockShox]

Can someone explain to me the differences (both in the pathogenesis and presenting signs/symptoms) among acute and chronic cholecystitis, biliary cholic, choledocholithiasis, and cholelithiasis?

Cholecystisis is inflammation of the gallbladder due to the blockage of the cystic duct, etc. The acute would be new the chronic would be recurrent. The symtoms are RUQ pain sometime radiating to the back, nausea, vomiting, and low-grade fever. There will be peritoneal signs (which does not happen in biliary colic), + murphy sign, and labs can be either entirely normal or show elevated alk phos. Biliary colic is similar a pain but there is not the inflammation and fever as seen in cholecystitis nor are there the signs as mentioned above. It usually resolved in 1-5 hours after eating and comes and goes. The patient is usually unable to stand still (this is different from a kidney stone where they tend to not move). This can eventually lead to cholecystisis.

Cholecystitis is often caused by (but not exclusively) cholelithiasis. Cholelithiasis as the name implies is stones in the gallbladder. Most people with stones are asymptomatic but sometimes a stone leads to cholecystitis. These are most often cholesterol stones, but watch for questions with sickle cell patients or thalassemias who can have pigmented stones.

Choledocholithiasis as the name implies is a stone in the common bile duct.

So as you can see the former is the disease and the latter are the etiologies. While the former can be diagnosed clinically the latter can only be diagnosed by actually imaging the GB and seeing the stones.