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Clin Med - GI > Disorders of Gallbladder and Biliary Tree > Flashcards

Disorders of Gallbladder and Biliary Tree Flashcards

1
Q

What is Cholelithiasis

A

aka gallstones
hardened deposits of digestive fluid that form in the galbladder

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2
Q

what are complications of gallstones

A

cholecystitis
cholangitis
choledocholithiasis
gallstones pancreatitis
cholangiocarcinoma (rare)

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3
Q

what are risk factors for cholelithiasis

A

female
obesity
increased age
pregnancy/OCPs
American Indian ethnicity
western diet, TPN
Rapid weight loss
family hx

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4
Q

what are the pathways for gallstone formation

A

cholesterol supersaturation
excess bilirubin
gallbladder hypomotility or impaired contractility

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5
Q

What patients have decreased bile salt secretion

A

cystic fibrosis

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6
Q

what are black pigment stones

A

small, hard gallstones composed of calcium bilirubinate and inorganic CA salts
associated wtih alchol-related liver disease

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7
Q

what are brown pigment stones

A

soft and greasy, consisting of bilirubinate and fatty acids
- infection, infalmation, parasitic - rare in US

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8
Q

What is biliary sludge

A

precursor to cholelithiasis
consists of calcium bilirubinate, choesterol microcrystals and mucin
develops during gallbladder stasis

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9
Q

what is the clinical presentation of cholelithiasis

A

most asymptomatic
Biliary colic most common symptom - RUQ pain radiating to scapula (or down right arm), sudden onset, intense in 15min to 1 hour, remains steady then gradually resolves over 30-90 minutes (temporary obstruction)

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10
Q

What are the initial workup for cholelithiasis

A

CBC, CMP, PT/PTT< lipase, amylase, alk phos, tot bilirubin, UA (usually normal)
US first line and best imagine

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11
Q

What is a HIDA scan

A

Evaluation of cholelithiasis with radioactive tracer

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12
Q

what is the treatment of asymptomatic gallstones

A

counsel regarding symptoms and when to get medical tx
PO/Parenteral analgesia in ER/urgent care
diet changes to reduce chances of recurrent episodes

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13
Q

what are stone dissolution treatments for cholelithiasis

A

Actigall/ursodiol

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14
Q

what is the treatment of choice for symptomatic cholelithiasis

A

laparoscopic cholecystectomy

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15
Q

what is inflammation of the gallbladder that develops over hours, usually because of obstructing gallstone in cystic duct

A

acute cholecystitis

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16
Q

what are symptoms of acute cholecystitis

A

RUQ pain and tenderness; maybe fever, chills, n/v

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17
Q

what is the treatment for acute cholecystitis

A

usually ABX and cholecystectomy

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18
Q

what is the clinical presentation of acute cholecystitis

A

most with prior attacks of biliary colic or acute cholecystitis
severe RUQ pain > 6hours with bloating, foot intolerances, increased gas, n/v, pain in midback/shoulders
Murphys sign

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19
Q

what is the first test in the ED for acute cholecystitis

A

CT scan; r/o GB perforation or pancreatitis

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20
Q

what is the best test to detect gallstones and evaluate GB disease

A

Transabdominal gallbladder US

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21
Q

What is Acute acalculous cholecystitis

A

cholecystitis without stones
risks: critical illness, prolonged fasting/TPN, Shock, immune deficiency, vasculitis, children

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22
Q

what test is more helpful for acute acalculous cholecystitis

A

HIDA scan more helpful; failure to fill may indicate edematous cystic duct obstruction

23
Q

what are complications of acute acalculous cholecystitis

A

if untreated, rapid progression to GB gangrene and perforation, sepsis, shock, peritonitis, mortality 65%

24
Q

What is the treatment for acute cholecystitis

A

admit, iv analgesics, NPO, NG suction if vomiting, IV abx if concern for infection
cholecystectomy cures acute choecystitis and relieves biliary pain

25
Q

what is Mirizzi syndrome

A

rare; stone impacted in cystic duct, compresses and obstructs CBD, causing cholestasis

26
Q

What is cholecystoenteric fistula

A

rare; large stone erodes GB wall, creating fistula into small bowel; stone may pass freely or obstruct small bowel (gallstone ileus)

27
Q

What is chronic cholecystitis

A

prolonged, subacute condition; mechanical or functional dysfunction of GB emptying

28
Q

what is porcelain gallbladder

A

extensive calcification due to fibrosis

29
Q

What is the classic montra for cholecystitis

A

fat, forty, fertile, female, (flatulant)

30
Q

What is the clinical presentation of chronic cholecystitis

A

dull RUQ pain, radiate mid back/right scapula; usually associated with fatty food ingestion
c/o N/v, bloating, flatulence; usually later evenin

31
Q

what is the classic physical exam of chronic cholecystitis

A

+ murphys sign
not acutely ill but uncomfortable
vitals usually WNL

32
Q

What is the test of choice for the diagnosis of chronic cholecystitis

A

US
HIDA best to confirm acalculous cholecystitis

33
Q

what is the treatment for chronic chollecystitis

A

laparoscopic cholecystectomy
milder/poor surgical candidates: strict low fat and low spice diets or Actigall (ursodiol)

34
Q

what is choledocholithiasis

A

presence of stones within the common bile duct (CBD)
primary: form in bile duct
secondary: form in GB but migrate to bile duct

35
Q

What is the clinical presentation of CBD stones

A

pain: colicky, RUQ, mod severity: intermittent and recurrent
episodic hx epigastric, RUQ pain
may have episodic icterus/jaundice; pruritis, n/v, clay-colored stools, tea-colored urine

36
Q

What is Courvoisier’s sign

A

presence of palpable GB (GB dilation due to obstruction of CBD)

37
Q

What bloodwork is done for choledocholithiasis

A

CMC/CMP
Lipase
INR/PT

38
Q

what is the diagnostic test of choice for choledocholithiasis

A

abdominal US

39
Q

what is the treatment for choledocholithiasis

A

ERCP (with spincterotomy to remove stone/s)

40
Q

What is acute cholangitis

A

CBD obstruction allows bacteria to ascent from duodenum

41
Q

what is charcot triad

A

abdominal pain, jaundice, fever or chills
(cholangitis)

42
Q

what is reynolds pentad

A

confusion, hypotension, abdominal pain, jaundice, fever and chills
(cholangitis)

43
Q

What is recurrent pyogenic cholangitis

A

characterized by intrahepatic brown pigment stone formation
occurs in southeast asia
sludge and bacterial debris in bile ducts

44
Q

what is the treatment of acute cholangitis

A

emergency requiring aggressive supportive care and urgent removal of stones, endoscopically or sugically
abx likely acute
alternative for very ill: meropenem, ciprofloxacin plus metrinidazole

45
Q

what is the treatment of recurrent pyogenic cholangitis

A

supportive care (broad-spectrum abx), eradicate any parasites and mechanically clear ducts of sotnes and debris via ERCP or surgically

46
Q

what are the common organisms associated with acute cholangitis

A

gram negative (e.coli, klebsiella, enterobacter)

47
Q

what is primary sclerosing cholangitis

A

chronic and progressive patchy inflammation, fibrosis, and strictures of bile ducts that has no known cause
80% have IBD, most often ulceratlive colitis

48
Q

what procedure is indicated with primary sclerosing cholangitis

A

liver transplant

49
Q

what is the pathophysiology of primary sclerosing cholangitis

A

progressive fibrosis around intrahepatic bile ducts lead to concentric and circumferential laminations
“onion skin” fibrosis

50
Q

what is the clinical presentation of PSC

A

50% asymptompatic- dx after abnormal LFTs found when tested for other reasons
c/o RUQ pain, pruritis, fatigue, jaundice
development of symptomatic gallstoens and choledocholithiasiss

51
Q

what are the subtypes of PSC

A

classic
small duct
associated with autoimmune hepatitis

52
Q

what is seen on PE with PSC

A

hepatomegally, splenomegally, jaundice, excoriations from prurutis
fever, chills, RUQ pain, +/- jaundice; onset bacterial cholangitis

53
Q

what is rerquired for diagnosis of PSC

A

US
cholangiography- multiple strictures and dilations in intrahepatic and extrahepatic bile ducts - ERCP

54
Q

what is acute cholecystitis

A

stone lodged in cystic duct causes GB to become distended and inflamed; fever, RUQ pain and murphys sign

Clin Med - GI (11 decks)

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