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Flashcards in Biliary Tract Deck (42):
1

3 parts of gallbladder

fundus
body
neck

2

Most important part of gallbladder

neck because there is a groove that meets the cystic pouch (Hartmann's pouch) where stones get stuck

3

common bile duct

cystic duct + hepatic duct

4

Function gallbladder

store bile
bile emulsifies fat- assisting with absorption of fates

5

Patho cholelithiasis

bile-->vesicles-->crystal-->stone

6

Most likely to get cholelithiasis

Native Americans

7

uncomplicated gallbladder disease

biliary colic in the absence of complications such as cholecystitis, cholangitis, or gallstone pancreatitis

8

RF cholelithiasis

Age
women
FHx
Pregnant
Obesity
Rapid weight loss
Diabetes
HyperTG
Medications- OCP, hormone replacement, ceftriaxone
Gallbladder stasis
Decrease physical activity

9

Prevent cholelithiasis

statins
coffee
vegetable protein and nuts
Mediterranean diet- poly/monounsaturated fats
exercise

10

Complications cholelithiasis

acute cholecystits
gallstone pancreatitis
bouvert syndrome (gallstone ileus)

11

Clinical cholelithiasis

asymptomatic
biliary colic RUQ after fatty meal (voluntary guarding)
non-specific abdominal pain
mid epigastric pain
chest pain
full after meal
abdominal distention
N/V
diaphoresis

12

Dx cholelithiasis

CBC with diff
LFT normal- ALT higher than AST if cholestatic pattern
RUQ/abdominal ultrasound

13

Tx cholelithiasis

- Asx/incidental finding= expentant management (signs/sx to look for)
- Sx= prophylactic cholecystectomy

14

Def cholecystitis

inflammation of the gallbladder

15

Acute cholecystitis

RUQ pain, fever, leukocytosis with gallbladder inflammation

16

Acalculous Cholecystitis

identical to acute but without gallstone

17

chronic cholecystitis

recurrent infection or chronic mechanical irritation of galllstones--> fibrosis and thickening of GB

18

Complications fo acute cholecystitis

gangrene of gallbladder
gallbladder perforation--> pericholecystic abscess
emphysematous cholesystitis
mirrizi syndrome- hepatic duct compresses--> jaundice
gallbladder rupture
chronic cholecystitis

19

Sequelae acute cholecystitis

- porcelain gallbladder- discolored brittel consistency due to Ca2+
- strawberry gallbladder- villi enlarged due to cholesterol and look like strawberry
- xanthogranulomatous cholecystitis- macrophage in gladder
- fistulization to the gallbladder
- carcinoma of the gallbladder

20

Clinical acute cholecystitis

- sudden onset RUQ pain/ epigastric after a fatty meal
-N/V
- Murphy sign
- Fever
- Jaundice
- Courvoisier's sign

21

Dx acute cholecystitis

CBC with diff- leukocytosis with left shift
LFT increased, bilirubin increased is obstruction; ALT higher than AST
RUQ/Abdominal ultrasound

22

Tx acute cholecystitis

Admit to hospital (IVF, pain management, ABX)
cholecystectomy within 24hrs
Pre-op ABX- Cipro and Flagyl, 3rd gen ceph + flagyl, carbapenem

23

Percutaneous drainage indications for acute cholecystitis

pericholecystic abscess
CBD obstruction
significant edema and swelling

24

Def choledocholithiasis

gallstones in the bile duct

25

Complications choledocholithiasis

acute cholangitis
acute pancreatitis
hyrops gallbladder
acute cholecystitis

26

Clinical choledocholithiasis

-biliary type pain
- RUQ mid epigastric pain or shoulder pain
- afebrile
- N/V
- jaundice and/or fever if complicated

27

Dx choledocholithiasis

CBC with diff- normal
LFT will be cholestatic pattern if stone retained
RUQ ultrasound
MRCP- no confirmed stone but need to know if have
ERCP- confirmed stone that needs out
CT with contrast

28

Tx choledocholithiasis

- removal of common bile duct via endoscopically (ERCP) or surgical
- most ptn with choledocholithiasis operative repair will have cholecystectomy as well

29

Def acute cholangitis

bacterial infection with biliary obstruction

30

Cause acute cholangitis

biliary calculi
benign stenosis
malignancy

31

MC organism in acute cholangitis

e.coli

32

Clinical acute cholangitis

abdominal pain
fever
yellow skin
wakness
charcot triad
reynolds pentad

33

charcot triad

fever, abdominal pain, jaundice

34

Reynold's pentad

fever
abdominal pain
jaundice
confusion
hypotension

35

Dx acute cholangitis

CBC with diff- leukocytosis with left shift
LFT- elevated cholestatic pattern
Blood culture
Abdominal ultrasound first
MRCP or ERCP second

36

Tx acute cholangitis

admit to hospital
empiric ABX- Zosyn, Unasyn, Fluoro + Flagyl, Carbapenem
Establish biliary drainage
- ERCP- sphincterotomy with stone excision or stent placement

37

Patho Primary Sclerosing Cholangitis

chronic progressive disorder leading to complications of cholestasis and hepatic failure--> multifocal strictures, segmental dilations--> end stage liver disease

38

PSC leads to increased risk of what

cholangiocarcinoma, gallbladder cancer, HCC

39

Who gets PSC

men 20-25

40

Clinical PSC

asymptomatic
jaundice
splenomegaly
fatigue
pruritis

41

DX PSC

LFT with cholestatic pattern
MRCP

42

Tx PSC

liver transplant
symptomatic relief- UDCA, biliary stents