biliary disease pearls Flashcards
severe intense crampy abdominal pain==colic
suggest which dz
obstruction of a hollow viscera; ex: biliary
possible reasons for dark urine
hematuria
bilirubinuria
hyperbilirubinEmia possible causes
CBD obstruction or hepatitis
ascending cholangitis/
emergency?
yeS!
CBD obstruction or hepatitis =>dark urine
pathophys
CBD obstruction or hepatitis=>conjugated hyperBilirubinEmia=> dark urine
in case of bilirubinuria;
can Dark urine precede jaundice
yeS!
rigors suggest?
bacteremia = life-threatening bacterial infection.
ascending cholangitis/
REALLY common sx/
what should be done about it?
Bacteremia =exceptionally common in ascending cholangitis.
Tx= Abx administered promptly to pts w suspected.diagnosis
acute RUQ or epigastic pain +
ass.sx= short episode of pain +
NO jaundice or fever +
nl LFT & lipase/
consider…/
tests to perform
biliary colic
RUQ Ultra sound
acute RUQ or epigastic pain +
ass.sx= persistent pain +
NO jaundice or fever POSSIBLE +
nl LFT & lipase/
consider…/
tests to perform
choleCystitis/
RUQ US :
GS w/in GB =>wall thickening or edema
acute RUQ or epigastic pain +
ass.sx= persistent pain +
fever possible +
LFT incr+ incr. bilirubin & incr lipase/
consider…/
tests to perform
choleDochoLithiasis+
ascending cholits or
pancreatitis (incr lipase) /
tests:
US;
EUS= endoscopic US/
ERCP/ MRCP
sx suggesting Choledocholithiasis
ANY of the following:
a. Cholangitis
b. Jaundice
c. Dilated CBD on ultrasound
d. Elevated alkaline phosphatase
e. Elevated amylase or lipase
pancreatitis/
tests/
why serum lipase used instead of serum amylase
Remains elevated longer than serum amylase
Marked elevations =>pancreatitis secondary to gallstones
