Biliary Dz Flashcards
(74 cards)
1
Q
What is the function of Bile?
A
- Digestion and absorption of fats
- Excretion of bilirubin
- Excretion of cholesterol
- Excretion of metabolic by-products
2
Q
Who is Cholelithiasis MC in?
A
- Native Americans
- Hispanics
- Caucasians
3
Q
What are the most common type of gallstones?
A
Cholesterol stones
4
Q
What is the MC presentation of Cholelithiasis?
A
ASX
5
Q
How will a pt present with cholelithiasis IF they are symptomatic?
A
Biliary colic
6
Q
US findings in Cholelithiasis
A
- Gallstones
- Wall thickening
- Pericholecystic fluid
- “Shadowing”
7
Q
SYMPOTOMATIC Cholelithiasis treatment
A
Cholelithiasis + Biliary Colic= Cholecystectomy
8
Q
Define Biliary Colic
A
TEMPORARY obstruction of cystic duct
9
Q
Biliary Colic etiology
A
Gallstones
10
Q
Biliary Colic clinical presentation
A
“GB Attack” Following a fatty meal
- Dull, constant RUQ pain
- +/- Radiation to shoulder
- N/V, diaphoresis
- Temporary sx’s: 4-6 hrs
11
Q
Biliary Colic PEx findings
A
Basically Negative:
- NO jaundice
- Negative Murphy’s sign
12
Q
Lab findings in Biliary Colic
A
NORMAL
13
Q
US findings in Biliary Colic
A
Gallstone and/or Sludge causing temporary cystic duct obstruction
14
Q
Biliary Colic Tx
A
Prophylactic Cholecystectomy
15
Q
When should you consider Biliary Dyskinesia?
A
In pt’s with typical biliary colic who:
- Negative US: NO gallstones or sludge
- Normal labs: CBC, LFT’s, amylase, lipase
16
Q
What is the imaging of choice in suspected Biliary Dyskinesia?
A
HIDA Scan w/ CCK
17
Q
Who do you NOT give CCK (given with HIDA scan) to?
A
Pt with suspected Gallstones
18
Q
When is a Cholecystectomy recommended in Biliary Dyskinesia?
A
- Typical Biliary sx’s
- HIDA scan w/ CCK EF: <35-40%
- Ruled out other diagnosis
19
Q
Define Cholecystitis
A
Acue inflammation of GB d/t sustained obstruction of cystic duct: Cholesterol stones MCly
20
Q
Acute Cholecystitis si/sx’s
A
- Steady, severe RUQ pain
- +/- radiation to shoulder/flank
- Following fatty meal
- N/V, diaphoresis
- FEVER
- Persistent sx’s: >4-6 hrs
- h/o biliary colic
21
Q
Acute Cholecystitis PEx findings
A
- RUQ tenderness
- Positive Murphy’s
- Fever
- Tachycardia
- NO jaundice
22
Q
Acute Cholecystitis complications
A
- Gangrene: 20%
- Perforation
- Generalized peritonitis
- Gallstone ileus
- Cholecystoenteric fistula
23
Q
Acute Cholecystitis lab findings
A
- Elevated WBC w/ left shift
2. UA: Elevated urobilinogen
24
Q
What is the INITIAL diagnostic imaging of choice in Acute Cholecystitis?
A
US
25
US findings in Acute Cholecystitis
1. Gallstones
2. Wall thickening: >4-5 mm
3. Pericholecystic fluid
4. + Sonographic Murphy's sign
26
What imaging is used to CONFIRM the diagnosis of acute cholecystitis?
HIDA Scan: Failure of GB to fill in setting of cystic duct obstruction
27
Acute Cholecystitis management
1. Early Cholecystectom: Recommended in healthy, low risk pt's (ASA class I and II)
2. IV Abx (+/-): Ciprofloxacin + Metronidazole
28
Acute Cholecystitis management in HIGH risk pt's (ASA III, IV, V)
1. Supportive therapy
2. Consult Specialist: Surgery, pulmonologist for surgical clearance
3. Percutaneous cholecystectomy tube for decompression: If medical therapy fails
29
Who is Acalculous Cholecystitis common in? Prognosis?
Critically Ill patients
| Worse prognosis
30
What is Acalculous Cholecystitis associated with?
1. Stasis
| 2. Ischemia
31
Acalculous Cholecystitis presentation
1. NO gallstones
| 2. +/- Jaundice
32
Acalculous Cholecystitis treatment
1. Cholecystectomy vs. Cholecystostomy
2. Blood cultures
3. Broda spectrum Abx
33
Define Choledocolithiasis
Stone in common bile duct (CBD)
34
Choledocolithiasis clinical presentation
1. Asx
2. RUQ or Epigastric pain
3. Jaundice: Tea colored urine, light colored stools, pruritus
4. Hx biliary colic
35
Choledocolithiasis PEx findings in uncomplicated dz
1. Jaundice
2. Sclereal Icterus
3. +/- RUQ tenderness
4. NO peritoneal signs
5. NO fever
36
Uncomplicated Choledocolithiasis lab findings
1. Elevated conjugated bilirubin
| 2. Elevated alk. phosph
37
INITIAL imaging of choice in Choledocolithiasis? Findings?
US: CBD stone, Dilated CBD, gallstones in GB
38
imaging of choice to CONFIRM Choledocolithiasis
MRCP
39
What is the preferred therapeutic test in the treatment of Choledocolithiasis?
ERCP:
1. Remove stones
2. Insert stent
3. Sphincterectomy
4. CCY follows
40
Complications of imaging of choice in Choledocolithiasis
1. Cholangitis
| 2. Pancreatitis
41
Define Ascending Cholangitis
ascending INFECTION from duodenum of biliary tract: MCly CBD
| associated with CBD stone
42
Ascending Cholangitis acute presentation
Charcot's Triad:
1. Fever/chills
2. RUQ pain
3. Jaundice
43
What is Reynold's Pentad?
Charcots + Hypotension (shock) + AMS
| 50% mortality rate
44
Lab findings in Ascending Cholangitis
1. Marked Leukocytosis; >20,000
2. Elevated conjugated bilirubin
3. Elevated Alk Phos
4. UA: elated urobilinogen
45
Ascending Cholangitis management
1. ERCP w/ sphincterectomy and stone extraction
| 2. Follow with CCY
46
Who does Primary Biliary Cirrhosis (PBC) the MC in?
Females
| Ages 35-60
47
Primary Biliary Cirrhosis etiology
Autoimmune destruction of small intrahepatic bile ducts
48
What can Primary Biliary Cirrhosis lead to?
1. Cirrhosis
| 2. Liver Failure
49
What are the main presenting sx's in Primary Biliary Cirrhosis?
1. Fatigue
| 2. Pruritus: BEFORE the jaundice
50
other presenting sx's in Primary Biliary Cirrhosis?
1. RUQ pain
2. Hepatomegaly
3. Arthritis
4. Skin hyperpigmentation
5. Xanthomas
6. CREST sx: Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, Telangiectasias
51
LFT findings in Primary Biliary Cirrhosis?
Cholestatic pattern
1. Elevated Alk phos
2. Elevated conjugated bilirubin: later in dz
3. Elevated GGT*
52
What is the hallmark lab finding in Primary Biliary Cirrhosis?
+ AMA (Anti-mitochrondrial antibody)
53
What do you need to CONFIRM Primary Biliary Cirrhosis?
Liver Bx
54
What is another condition/disorder found in 50% of pt's with Primary Biliary Cirrhosis?
Hyperlipidemia
55
Primary Biliary Cirrhosis management?
Urso
56
What do you want to make sure to monitor in Primary Biliary Cirrhosis? Why?
Bone density: DEXA d/t increased risk of osteoporosis
57
Who does Primary Sclerosing Cholangitis (PSC) MC in?
Men
58
What condition do over 75% of patients with Primary Sclerosing Cholangitis also have?
IBD: Ulcerative Colitis
59
Median survival following Primary Sclerosing Cholangitis dx?
10-12 yrs
60
Primary Sclerosing Cholangitis Complications
1. Biliary Stricture
2. Cholangitis
3. CA: GB, Colon, Cholangiocarcinoma
61
Primary Sclerosing Cholangitis (PSC) clinical presentation?
1. Fatigue
2. PruritIs AFTER jaundice
3. Steatorrhea
62
What is the preferred imaging in the diagnosis of Primary Sclerosing Cholangitis (PSC)? Why?
ERCP: both diagnostic and therapeutic
63
MRCP findings in Primary Sclerosing Cholangitis (PSC)
Multifocal stricturing w/ intrahepatic/extrahepatic ductal dilation
64
Primary Sclerosing Cholangitis Management
ERCP: Biliary ductal dilation or stenting
65
What do you want to make sure to monitor in Primary Sclerosing Cholangitis (PSC)? Why?
Bone density d/t osteoporosis
66
Define Gilbert Syndrome
Deficiency in enzyme for glucuronidation of bilirubin in liver (conjugation)
67
When should you suspect Gilbert Syndrome?
UNCONJUGATED hyperbilirubinemia in the ABSENCE of hemolysis= normal CBC, blood smear, reticulocyte count
Normal LFTS
68
What makes up 50% of biliary tract CA?
GB CA
69
RF's for GB CA?
1. Cholelithiasis
2. GB polyps >1 cm
3. Salmonellla infxn
70
What is the main presenting sx in Cholangiocarcinoma?
Jaundice!
71
Lab findings in Cholangiocarcinoma?
Cholestatis-Obstructive pattersn
1. Elevated conjugated bilirubin
2. Elevated alk phos
3. Elevated CA 19-9
72
What is Ampulla CA associated with?
1. Familial Adenomatous Polyposis (FAP)
| 2. Hereditary Non-Polyposis Colon CA (HNPCC)
73
What is the MC presenting sx in Ampulla CA?
Obstructive Jaundice
74
Other presenting sx's in Ampulla CA
1. Occult GIB with microcytic anemia
| 2. Abdominal pain
