Always On EM - Mayo Clinic Emergency Medicine Chapter 40 - The Full Bird and Fumar de Cystica - an EM guide to the gallbladder
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Feb 1, 2025 Dr. Henry Schiller, a Mayo Clinic Professor of Surgery and Army Reserve Lieutenant Colonel, shares his expertise on gallbladder health. He discusses the formation of gallstones and the significance of timely diagnosis. The conversation delves into differentiating gallstones from cholecystitis, highlighting critical imaging techniques like ultrasound and CT scans. Insights into interpreting liver function tests and the complexity of acalculous cholecystitis are explored, along with engaging personal anecdotes from his medical journey.
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Closed-Loop Physiology in Cholecystitis
- Cholecystitis is caused by closed-loop physiology, similar to compartment syndrome.
- Distension causes lymphatic collapse, venous obstruction, and ultimately, ischemia and infection.
Prompt Cholecystitis Treatment
- Treat cholecystitis promptly with surgery or drainage procedure if surgery is high-risk.
- Delaying treatment increases the risk of complications like bile duct injury or cystic duct leak.
When to Call a Surgeon
- Call a surgeon if a patient with gallstones has pain for eight hours, even if the ultrasound doesn't show cholecystitis.
- The surgeon may disagree, but the right approach is cholecystectomy.