CC Jan 2016 Gallbladder Disease in Children

echoecho's version from 2016-01-05 14:49


Question Answer
The prevalence of cholelithiasis in children has ______ (increased vs. decreased) significantly from 1959 to the present? increased (from 0.5% to a current estimate of 1.9-4.0%)
About 20% of affected children have hemolytic disease, list examples?1) sickle cell anemia 2) hereditary spherocytosis
50% of children with sickle cell disease will have gallstones by the time they are ___ years of age?22
Of the remaining children > 3 years of age WITHOUT hemolytic disease, ____% were overweight or obese?69
List 2 other independent risk factors?1) older age 2) Hispanic ethnicity
List other predisposing factors?1) cystic fibrosis (incidence of cholelithiasis up to 12%) 2) hepatobiliary disease 3) prolonged parenteral nutrition 4) increased estrogen (pregnancy and oral contraceptives) 5) trauma 6) sepsis 7) abdominal surgery
Prior to puberty, gallstones occur equally in males and females, after puberty, they are 4 times more common in what gender?female
Types of gallstones formed are different in children and adults, true or false?true
Nearly half of gallstones in children are ____ ____ stones?black pigment
Black pigment stones are generally related to ______, and most common in patients with sickle cell disease and hereditary spherocytosis?hemolysis
What type of gallstones, while rare in adults, accounts for 25% of stones in children?calcium carbonate
What type of gallstones accounts for 25% of stones and are more common in obese children?cholesterol
While cholelisthiasis may be an incidental finding in children, are the majority of children asymptomatic or symptomatic?symptomatic
Infants < 1 year of age most commonly present with what symptom?janudice
Older chidlren may present with what s/s?RUQ abdominal pain of biliary colic OR with nonspecific abdominal pain accompanied by nausea and vomiting
The above s/s is the more typical presentation for ______ children?younger
What potential complication may not be easy to separate from symptomatic cholelithiasis or cholecystitis?pancreatitis
What is the imaging modality of choice?US
*** What is the management for asymptomatic neonates and infants found to have gallstones and why? What is the management for children with asymptomatic gallstones?1) expectant management because spontaneous resolution often occurs 2) observation
What is the managment for children with biliary colic WITHOUT acute cholecystitis?symptomatic management with fluids, diet modification and analgesics along with outpatient surgical consultation
There is very limited experience with nonsurgical treatment, comment on this?nonsurgical treatment like UDCA (ursodeoxycholic acid) to dissolve stones - although side effects are minimal, the risk of recurrent stones is significant
What is the management for acute cholecystitis?laparoscopic cholecystectomy (safe and effective in children)
*** Children with sickle cell disease and cholelithiasis usually receive management with what?prophylactic cholecystectomy
*** IN this population the risks of emergency surgery are significantly higher than in the general population and inflammation and infection of the gallbladder may provoke a _____ crisis?hemolytic
What is an acceptable procedure for diagnosis in neonatal cholestatis and for therapeutic benefits in biliary obstruction and post-laparoscopic cholecystectomy complications?ERCP (endoscopic retrograde cholangiopancreatography)
An unusual etiology for cholelithiasis in children is use of what? Explain?1) ceftriaxone (Rocephin) 2) the medication is concentrated in bile after excretion and causes reversible pseudolithiasis in 25-40% of children receiving the medication for > 4 days 3) Stones are precipitates of calcium and Ceftriaxone 4) while these children may be symptomatic, intervention is seldom necessary as the stones resolve with antibiotic discontinuation and proper hydration
With the obesity epidemic in children, providers ineed to include ______ as part of their differential dx for children with abdominal pain, jaundice, food intolerance or other GI symptoms?cholelithiasis
*** SUMMARY = The prevalence of cholelithiasis is rising in children. ____% of affected children have hemolytic disease?20
*** SUMMARY = The majority of children with cholelithiasis are _______ (symptomatic vs. asymptomatic) and what is the imaging modality of choice?symptomatic; US
*** SUMMARY = What is the appropriate management for asymptomatic children with cholelithiasis?observation