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Gastroenterology > Biliary Disorders > Flashcards

Biliary Disorders Flashcards

1
Q

gallstones due to increased circulating cholesterol OR bile over-concentration from incomplete or infrequent emptying

A

cholelithiasis

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2
Q

what are gallstones mostly composed of?

A

cholesterol

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3
Q

a patient presents with RUQ pain + tenderness that is worse with fatty, greasy, and large meals, peaks 30 mins postprandial and causes substernal chest pain and radiates to right scapula, flank, or shoulder. Dx?

A

cholelithiasis

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4
Q

pain that comes and goes

A

biliary colic

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5
Q

what can be a clinical finding in cholelithiasis under the RUQ costal margin?

A

murphy sign; inspiration stops due to deep palpation

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6
Q

what is the 1st line imaging for suspected cholelithiasis?

A

RUQ ultrasound

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7
Q

what is the treatment of choice for cholelithiasis in symptomatic patients?

A

laparoscopic cholecystectomy

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8
Q

what 2 pain meds can be used for cholelithiasis?

A

NSAIDs
dicyclomine (anticholinergic)

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9
Q

during which trimester is preferred for a laparoscopic cholecystectomy in a pregnant patient with symptomatic cholelithiasis?

A

2nd trimester

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10
Q

what are 4 indications for a prophylactic cholecystectomy in patients with asymptomatic cholelithiasis?

A

calcified gallbladder
gallstones > 3cm in diameter
LITH gene
bariatric / cardiac transplant candidates

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11
Q

what treatment can be used for cholelithiasis to dissolve small cholesterol stones and is useful to reduce the risk of stone formation during rapid weight loss?

A

ursodeoxycholic acid

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12
Q

inflammation and infection within the gallbladder due to a stone becoming impacted in the cystic duct and inflammation develops behind the obstruction

A

acute cholecystitis

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13
Q

what is the most common cause of acute cholecystitis?

A

cholelithiasis

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14
Q

a patient presents with diaphoresis, N/V/D, acute unrelenting and severe epigastric/RUQ pain postprandial. on physical exam, patient is guarding and positive murphy sign with a fever. Dx?

A

acute cholecystitis

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15
Q

what sign will indicate worsening obstructive pathology in a patient with acute cholecystitis?

A

jaundice

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16
Q

what labs are likely seen in acute cholecystitis? (2)

A

leukocytosis
mildly elevated AST/ALT

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17
Q

what lab results can indicate worsening obstructive pathology in acute cholecystitis?

A

elevated bilirubin
elevated alk phos

18
Q

what is the 1st line study for acute cholecystitis? what will it show (3)?

A

transabdominal ultrasound

double wall sign
pericholecystic fluid
sonographic murphy sign

19
Q

what imaging can be used for acute cholecystitis if US results are negative, and is useful in diagnosing acalculous cholecystitis?

A

HIDA scan

20
Q

what is the medical management for acute cholecystitis? (4)

A

NPO
IV hydration
pain control (NSAIDs, morphine, hydromorphone, opiates)
ceftriaxone + metronidazole

21
Q

what is the surgical treatment/treatment of choice for acute cholecystitis?

A

laparoscopic cholecystectomy

22
Q

what is the treatment of choice for acute cholecystitis if a patient is too high risk for surgery?

A

cholecystostomy tube + antibiotics

23
Q

when do cholecystitis complications occur most?

A

when gallbladder cannot be removed

24
Q

chronic inflammation of the gallbladder due to repeated episodes of acute cholecystitis or irritation of the gallbladder by stones

A

chronic cholecystitis

25
Q

what is the treatment of choice for chronic cholecystitis?

A

laparoscopic cholecystectomy

26
Q

a stone obstructing flow within the common bile duct proximal to or distal to the pancreatic duct

A

choledocholithiasis

27
Q

a patient presents with jaundice, biliary colic, referred pain, N/V/D, and acholic stools. on physical exam, they have RUQ +/- MEG tenderness to palpation. Dx?

A

choledocholithiasis

28
Q

what sign indicates post-hepatic obstruction of the bile duct?

A

acholic stools

29
Q

what will labs show in a patient with choledocholithiasis? (4)

A

significantly elevated AST/ALT
elevated bilirubin
elevated alk phos
elevated amylase + lipase

30
Q

elevated amylase and lipase in choledocholithiasis indicates what?

A

secondary pancreatitis

31
Q

what is the 1st line imaging study for choledocholithiasis?

A

transabdominal ultrasound

32
Q

what is the diagnostic and treatment modality of choice with confirmed or high-risk bile duct stone in choledocholithiasis?

A

endoscopic retrograde cholangiopancreatography (ERCP)

33
Q

what size common bile duct is suggestive of choledocholithiasis?

A

> 6mm

34
Q

bacterial infection of the biliary tract that is most commonly caused by organisms ascending from the duodenum during episodes of biliary obstruction

A

acute cholangitis

35
Q

a patient presents with severe, episodic RUQ pain persisting for hours, fever, and jaundice. Dx?

A

cholangitis (charcot triad)

36
Q

a patient presents with severe, episodic RUQ pain persisting for hours, fever, jaundice, AMS, and hypotension. Dx?

A

suppurative cholangitis (reynolds pentad)

37
Q

what labs will be present in a patient with cholangitis? (5)

A

significantly elevated AST/ALT
elevated bilirubin
elevated alk phos
elevated amylase + lipase
leukocytosis

38
Q

what is the 1st line diagnostic for cholangitis?

A

transabdominal US

39
Q

what is the initial treatment for all patients with cholangitis? (3)

A

IV fluids
analgesics
ciprofloxacin + metronidazole OR piperacillin-tazobactam

40
Q

what is the treatment for a patient with unstable/septic cholangitis? (2)

A

biliary drainage
cholecystectomy when stable

Gastroenterology (26 decks)

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