Abdominal Trauma Big Exam 2 | Questions with 100% Correct Answers | Updated
&Verified | 2024-2025 | 100% Score
What is an inflammation of the gallbladder that occurs most commonly secondary to cystic duct
blockage by a gallstone and can be acute or chronic? - ✔✔Cholecystitis
How often are gallstones present in "Calculous Cholecystitis."? - ✔✔90-95% of cases
Cholecystitis cases that are not caused by a gallstones (acalculous) may be secondary to what? -
✔✔Sepsis or prolonged fasting, etc, and *can develop into Gangrene.*
What is the pathophysiology of acute cholecystitis? - ✔✔Gallstone blockage leads to distended and
tense gallbladder that may contain areas of ischemia with necrosis, as well as possible purulent
material.■ If acalculous, the pathophysiology is less clear. Could be due to retention and stasis of
concentrated bile.
What is the pathophysiology of chronic cholecystitis? - ✔✔Chronic irritation and inflammation of the
gallbladder that continues over time, usually secondary to repetitive bouts of acute cholecystitis.■Wall
becomes thickened and the gallbladder atrophies
What are the signs and symptoms of cholecystitis? - ✔✔○ The most common symptom is upper
abdominal pain.■ With acute cholecystitis, the pain frequently beings in the epigastricregion, then
localizes to the RUQ.○ Pain is often "colicky", but often becomes constant.■ Sometimes refers to the
right scapula/shoulder ○ Nausea and vomiting are generally present○ Often made worse by eating (esp
greasy foods). ○ Chronic cholecystitis presents with a more ill-defined picture of recurrent vague
abdominal pain.
Acute calculous cholecystitis is commonly seen in patients that are what? - ✔✔4 F's■ Female- Estrogen
increases risk of gallstones■ Forties- Premenopausal spikes in estrogen■ Fertile- Pregnant women have
higher estrogen■ Fat- May be related to cholesterol levels in bile
What diagnostics labs may suggests hepatobiliary disease, but are not always reliable for diagnosis of
cholecystitis? - ✔✔■ ALT and AST may be elevated■ Bilirubin and Alkaline Phosphatase may be
,elevated■ Generally Lipase is negative unless gallstone is in the ampulla of Vater causing pancreatic
obstruction as well ■ Leukocytosis is common
What should be done for all mature women with suspected cholecystitis? - ✔✔Before doing significant
diagnostic evaluations, all females of childbearing age should be tested for pregnancy.
What is the preferred imaging for cholecystitis? - ✔✔○ Ultrasound is the preferred initial imaging test. ■
Presence of cholelithiasis in combination with the sonographic Murphy's Sign is the most sensitive US
finding. ■ Gallbladder wall thickening and *pericholecystic fluid are additional sonographic evidence of
cholecystitis.*
What can be a helpful diagnostic test for cholecystitis if the Gallbladder Ultrasound is equivocal (2nd line
test).? - ✔✔○ Hepatobiliary Iminodiacetic Acid Scan, also known as HIDA Scintigraphy:
■ If the gallbladder is not visualized within a few hours after injection,this is highly suggestive of
cholecystitis or cystic duct obstruction.
■ For acute cholecystitis, sensitivity of 97% and specificity of 94%.
■ Nuclear imaging procedure to evaluate function of gallbladder.
■ Injected radioactive tracer is allowed to circulate to the liver, where it is excreted into the bile and
stored in the gallbladder.
What diagnostic studies are not recommended for cholecystitis as initial studies for several reasons like
radiation, cost, etc? - ✔✔○ CT of the abdomen with contrast, as well
as MRI with contrast.
■ Both can diagnose cholecystitis, but
are not recommended as initial studies for several reasons (radiation, cost, etc).
■ A special type of MR scan can be
used in cholelithias, called an MRCP (more to come).
What are ways to manage cholecystitis? - ✔✔Initial treatment depends on the severity and presence or
absence of complications (pancreatitis, hepatitis, gangrene, etc).
○ *Initial treatment may involve bowel rest, IV hydration, analgesia,
antiemetics, and IV antibiotics.*
,■ Piperacillin-Tazobactam (Zosyn) is a common choice
○ Uncomplicated cholecystitis can be treated on outpatient basis, often including Levofloxacin and
Metronidazole, antiemetics, etc.
○ Surgical intervention is often performed, emergently if complications
are present- Laparoscopic Cholecystectomy is standard of surgical care.
What are esophageal varices? - ✔✔Dilated submucosal esophageal veins,
generally located at the distal
esophagus.
○ Think of esophageal varices as the varicose veins or caput medusae of
the esophagus
How are esophageal varices developed? - ✔✔Secondary to portal HTN and seen in 50% of cirrhosis
patients. Approximately 1/3 of patients will develop an upper GI bleed.
Varices are usually asymptomatic until they bleed, but then what happens when they start to bleed? -
✔✔■ Painless, massive upper GI bleeding
■ Bright red blood or "coffee ground"
hematemesis possible
■ May present with hematochezia (bright red blood)
■ Due to massive size of bleed, may
develop postural hypotension,
tachycardia, and shock.
How do we diagnose a esophageal varice? - ✔✔Upper Endoscopy (EGD) is the standard for
visualizing the pathology and assessing the risk of hemorrhage.
■ If "Red Wheal" is present, varices are
considered "high risk for bleeding."
What are also very useful in assessing
, the severity and size of the varices, because visualizing the "extraluminal" varices EGD cannot be seen? -
✔✔CT and MRI (Barium esophagrams may reveal varices)
What is this diagram of? - ✔✔https://o.quizlet.com/mBn67zpZet4wKMC.aewClw_m.png
Emergency stabilization of the patient with esophageal varices may be necessary which includes what? -
✔✔Fluid and blood transfusion.
○ Immediate control of bleeding is necessary.
■ 30% mortality with 1st bleed; 50% within 6 weeks
What 2 managements are used for esophageal varices when not in an emergent situation? - ✔✔1.
Endoscopic evaluation with
*banding or sclerotherapy* to
stop the bleeding.
2. If these treatments are failing,
balloon tamponade may be required.
If the endoscopic treatments are not
working to stop the bleed, what is a procedure of last resort? - ✔✔* Transjugular Intrahepatic
Portosystemic Shunt (TIPS)*. It partially shunts blood away from liver, decreasing portal HTN. High risk
of mortality, but stops bleeding in 90% of those 10% of people that do not respond to endoscopic
banding attempts.
What is an inflammation of one
or more colonic diverticula? - ✔✔Diverticulitis
The out-pouches in diveticulitits can become swollen or
blocked off, leading to possible
overgrowth of bacteria within the
diverticula ranging from what to what? - ✔✔From inflammation
&Verified | 2024-2025 | 100% Score
What is an inflammation of the gallbladder that occurs most commonly secondary to cystic duct
blockage by a gallstone and can be acute or chronic? - ✔✔Cholecystitis
How often are gallstones present in "Calculous Cholecystitis."? - ✔✔90-95% of cases
Cholecystitis cases that are not caused by a gallstones (acalculous) may be secondary to what? -
✔✔Sepsis or prolonged fasting, etc, and *can develop into Gangrene.*
What is the pathophysiology of acute cholecystitis? - ✔✔Gallstone blockage leads to distended and
tense gallbladder that may contain areas of ischemia with necrosis, as well as possible purulent
material.■ If acalculous, the pathophysiology is less clear. Could be due to retention and stasis of
concentrated bile.
What is the pathophysiology of chronic cholecystitis? - ✔✔Chronic irritation and inflammation of the
gallbladder that continues over time, usually secondary to repetitive bouts of acute cholecystitis.■Wall
becomes thickened and the gallbladder atrophies
What are the signs and symptoms of cholecystitis? - ✔✔○ The most common symptom is upper
abdominal pain.■ With acute cholecystitis, the pain frequently beings in the epigastricregion, then
localizes to the RUQ.○ Pain is often "colicky", but often becomes constant.■ Sometimes refers to the
right scapula/shoulder ○ Nausea and vomiting are generally present○ Often made worse by eating (esp
greasy foods). ○ Chronic cholecystitis presents with a more ill-defined picture of recurrent vague
abdominal pain.
Acute calculous cholecystitis is commonly seen in patients that are what? - ✔✔4 F's■ Female- Estrogen
increases risk of gallstones■ Forties- Premenopausal spikes in estrogen■ Fertile- Pregnant women have
higher estrogen■ Fat- May be related to cholesterol levels in bile
What diagnostics labs may suggests hepatobiliary disease, but are not always reliable for diagnosis of
cholecystitis? - ✔✔■ ALT and AST may be elevated■ Bilirubin and Alkaline Phosphatase may be
,elevated■ Generally Lipase is negative unless gallstone is in the ampulla of Vater causing pancreatic
obstruction as well ■ Leukocytosis is common
What should be done for all mature women with suspected cholecystitis? - ✔✔Before doing significant
diagnostic evaluations, all females of childbearing age should be tested for pregnancy.
What is the preferred imaging for cholecystitis? - ✔✔○ Ultrasound is the preferred initial imaging test. ■
Presence of cholelithiasis in combination with the sonographic Murphy's Sign is the most sensitive US
finding. ■ Gallbladder wall thickening and *pericholecystic fluid are additional sonographic evidence of
cholecystitis.*
What can be a helpful diagnostic test for cholecystitis if the Gallbladder Ultrasound is equivocal (2nd line
test).? - ✔✔○ Hepatobiliary Iminodiacetic Acid Scan, also known as HIDA Scintigraphy:
■ If the gallbladder is not visualized within a few hours after injection,this is highly suggestive of
cholecystitis or cystic duct obstruction.
■ For acute cholecystitis, sensitivity of 97% and specificity of 94%.
■ Nuclear imaging procedure to evaluate function of gallbladder.
■ Injected radioactive tracer is allowed to circulate to the liver, where it is excreted into the bile and
stored in the gallbladder.
What diagnostic studies are not recommended for cholecystitis as initial studies for several reasons like
radiation, cost, etc? - ✔✔○ CT of the abdomen with contrast, as well
as MRI with contrast.
■ Both can diagnose cholecystitis, but
are not recommended as initial studies for several reasons (radiation, cost, etc).
■ A special type of MR scan can be
used in cholelithias, called an MRCP (more to come).
What are ways to manage cholecystitis? - ✔✔Initial treatment depends on the severity and presence or
absence of complications (pancreatitis, hepatitis, gangrene, etc).
○ *Initial treatment may involve bowel rest, IV hydration, analgesia,
antiemetics, and IV antibiotics.*
,■ Piperacillin-Tazobactam (Zosyn) is a common choice
○ Uncomplicated cholecystitis can be treated on outpatient basis, often including Levofloxacin and
Metronidazole, antiemetics, etc.
○ Surgical intervention is often performed, emergently if complications
are present- Laparoscopic Cholecystectomy is standard of surgical care.
What are esophageal varices? - ✔✔Dilated submucosal esophageal veins,
generally located at the distal
esophagus.
○ Think of esophageal varices as the varicose veins or caput medusae of
the esophagus
How are esophageal varices developed? - ✔✔Secondary to portal HTN and seen in 50% of cirrhosis
patients. Approximately 1/3 of patients will develop an upper GI bleed.
Varices are usually asymptomatic until they bleed, but then what happens when they start to bleed? -
✔✔■ Painless, massive upper GI bleeding
■ Bright red blood or "coffee ground"
hematemesis possible
■ May present with hematochezia (bright red blood)
■ Due to massive size of bleed, may
develop postural hypotension,
tachycardia, and shock.
How do we diagnose a esophageal varice? - ✔✔Upper Endoscopy (EGD) is the standard for
visualizing the pathology and assessing the risk of hemorrhage.
■ If "Red Wheal" is present, varices are
considered "high risk for bleeding."
What are also very useful in assessing
, the severity and size of the varices, because visualizing the "extraluminal" varices EGD cannot be seen? -
✔✔CT and MRI (Barium esophagrams may reveal varices)
What is this diagram of? - ✔✔https://o.quizlet.com/mBn67zpZet4wKMC.aewClw_m.png
Emergency stabilization of the patient with esophageal varices may be necessary which includes what? -
✔✔Fluid and blood transfusion.
○ Immediate control of bleeding is necessary.
■ 30% mortality with 1st bleed; 50% within 6 weeks
What 2 managements are used for esophageal varices when not in an emergent situation? - ✔✔1.
Endoscopic evaluation with
*banding or sclerotherapy* to
stop the bleeding.
2. If these treatments are failing,
balloon tamponade may be required.
If the endoscopic treatments are not
working to stop the bleed, what is a procedure of last resort? - ✔✔* Transjugular Intrahepatic
Portosystemic Shunt (TIPS)*. It partially shunts blood away from liver, decreasing portal HTN. High risk
of mortality, but stops bleeding in 90% of those 10% of people that do not respond to endoscopic
banding attempts.
What is an inflammation of one
or more colonic diverticula? - ✔✔Diverticulitis
The out-pouches in diveticulitits can become swollen or
blocked off, leading to possible
overgrowth of bacteria within the
diverticula ranging from what to what? - ✔✔From inflammation
