High -Yield Internal Medicine Board Exam Pearls by Knowmedge - HTML preview

4. Biliary Tract

The prevalence of gallstones is high in the United States, and thus should be

considered as part of a differential for a patient presenting with abdominal pain. Be able

to recognize and know how to treat acute cholecystitis, but also know when to expect

and how to treat acalculous cholecystitis.

Remember:

 Consider acalculous cholecystitis in patients with serious comorbidities,

including trauma, burns, or prolonged states of fasting

 Management is similar to that of acute calculous cholecystitis, but

patients with severe illness may require percutaneous drainage if unable

to tolerate surgery

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K N O W M E D G E

If choledocholithiasis is suspected, broad-spectrum antibiotics covering enteric gram-

negative bacteria should be started. Fluoroquinolones are usually a good initial choice.