radioisotope study - isotope concentrated in liver and secreted into bile - will demonstrate cholecystitis, bile leak, or CBD obstruction

Biliary Tract Flashcards by Lauren Chorny

what are the boundaries of the triangle of Calot?

Three C’s
cystic duct
common hepatic duct
cystic artery

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what is the source of alkaline phosphatase?

bile duct epithelium

- expect alkaline phosphatase to be elevated in bile duct obstruction

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what is in bile

cholesterol, lecithin, bile acids, and bilirubin

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what does bile do

emulsify fats

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what is the enterohepatic circulation

circulation of bile acids from liver to gut and back to the liver

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where are most of the bile acids absorbed

terminal ileum

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what stimulates gallbladder emptying

cholecystokinin and vagal input

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what is the source of CCK?

duodenal mucosal cells

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at what level of serum total bilirubin does one start to get jaundiced

2.5

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what are the signs and symptoms of obstructive jaundice

jaundice
dark urine
clay-colored stools (echoic stools)
pruritus
loss of appetite
nausea

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what causes the itching in obstructive jaundice

bile salts in the dermis

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what is cholelithiasis

gallstones in gallbladder

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what is choledocholithiasis

gallstone in the common bile duct

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what is cholecystitis

inflammation of the gallbladder

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what is cholangitis

infection of biliary tract

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what is cholangiocarcinoma

adenocarcinoma of bile ducts

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what is Klatskin’s tumor

cholangiocarcinoma of bile duct at the junction of the right and left hepatic ducts

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what is biliary colic

pain from gallstones, usually from a stone in cystic duct

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what is biloma

intraperitoneal bile fluid collection

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what is the initial diagnostic study of choice for evaluation of the biliary tract/gallbladder/cholelithiasis

ultrasound

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what is ERCP

endoscopic retrograde cholangiopancreatography

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what is PTC

percutaneous trans-hepatic cholangiogram

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what is HIDA scan

radioisotope study

isotope concentrated in liver and secreted into bile
will demonstrate cholecystitis, bile leak, or CBD obstruction

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how does HIDA scan reveal cholecystitis

nonopacification of the gallbladder from obstruction of the cystic duct

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what lab results are associated with obstructive jaundice

elevated alk phos, elevated bilirubin w/ or w/o elevated LFTs

what is cholelthiassi

formation of gallstones

what are the Big 4 risk factors for cholelithiasis

Female Fat Forty Fertile

what are the five major complications of gallstones

- acute cholecystitis - choledocholithiasis - gallstone pancreatitis - gallstone ileus - cholangitis

how is cholelithiasis diagnosed

ultrasound

what are indications for cholecystectomy in asymptomatic patient

sickle-cell calcified gallbladder patient is child

what is the major feared complication of ERCP

pancreatitis

what is the pathogenesis of acute cholecystitis

obstruction of the bile duct leads to inflammation of the gallbladder

what are the risk factors foracute cholecystitis

gallstones

what are the signs and symptoms of acute cholecystitis

- unrelenting RUQ pain or tenderness - fever - nausea/vomiting - painful palpable gallbladder - positive Murphy's sign - right sub scapular pain - epigastric discomfort

what are the complications of acute cholecystitis

abscess perforation choledocholithiasis cholecystenteric fistula formation

what lab results are associated with acute cholecystitis

increased WBC may have: - slight elevation of alk phos, LFTs - slight elevation in amylase, total bilirubin

what is the treatment of acute cholecystitis

IVFs, abx, and early cholecystectomy

what is acute acalculous cholecystitis

acute cholecystitis without evidence of stones

what is the pathogenesis of acute acalculous cholecystitis

sludge and gallbladder disuse and biliary stasis

what are the findings of acute acalculous cholecystitis on HIDA

non filling of the gallbladder

what is the management of acute acalculous cholecystitis

cholecystectomy

what is cholangitis

bacterial infection of the biliary tract from obstruction

what are the common causes of cholangitis

choledocholithiasis

what are the signs and symptoms of cholangitis

Charcot's triad - fever/chills - RUQ pain - jaundice

what is Reynold's pentad

Charcot's triad (fever/chills, RUQ pain, jaundice) + - mental status changes - shock

which organisms are most commonly isolated with cholangitis

gram negative organisms | - E. coli, Klebsiella, Psuedomonas, Enterobacter, Proteus, Serratia

what is suppurative cholangitis

severe infection with sepsis | - 'pus under pressure'

what is the management of cholangitis

nonsuppurative: - IVF and abx, definitive tx later suppurative: - IVF, abx, decompression

what is sclerosing cholangitis

multiple inflammatory fibrous thickenings of bile duct walls resulting in biliary strictures

what is the natural history of sclerosing cholangitis

progressive obstruction possibly leading to cirrhosis and liver failure

what is the major risk factor of sclerosing cholangitis

IBD

what type of IBD is the most common risk factor

ulcerative colitis

what are the signs and symptoms of sclerosing cholangitis

same as for obstructive jaundice: - jaundice - dark urine - itching - clay-colored stools - loss of energy - weight loss

how is sclerosing cholangitis diagnosed

elevated alk phos | PTC or ERCP revealing 'beads on a string'

what are the management options for sclerosing cholangitis

hepatoenteric anastomosis and resection of extra hepatic bile ducts because of risk of cholangiocarcinoma

what is gallstone ileus

SBO from a large gallstone that has eroded through the gallbladder and into the duodenum/small bowel

what is the classic site of obstruction in gallstone ileus

ileocecal valve

what are the classic findings of gallstone ileus

air int he hepatic bile ducts SBO with air fluid levels gallstone in ileocecal valve

what are the signs/symptoms of gallstone ileus

symptoms of SBO: - distention - vomiting - hypovolemia - RUQ pain

what are the diagnostic test of choice

abdominal xray - air in biliary tract | abdominal CT scan

what is the management of gallstone ileus

surgery

what is carcinoma of the gallbladder

malignant neoplasm arising in the gallbladder | - majority are adenocarcinoma

what are the risk factors for carcinoma of the gallbladder

gallstones, porcelain gallbladder, cholecystenteric fistula

what is a porcelain gallbladder

calcified gallbladder

what are the symptoms of carcinoma of the gallbladder

biliary colic, weight loss, anorexia - many are asymptomatic until late - may present as acute cholecystitis

what are the signs of carcinoma of the gallbladder

``` jaundice (from invasion of the CBD or compression by involved pericholedochal lymph nodes) RUQ mass palpable gallbladder (advanced disease) ```

what is the route of spread in carcinoma of the gallbladder

contiguous spread to the liver

what is cholangiocarcinoma

malignancy of the extra hepatic or intrahepatic ducts | - primary bile duct cancer

what is the histology of cholangiocarcinoma

almost all are adenocarcinomas

what are the signs/symptoms of cholangiocarcinoma

those of biliary obstruction: | - jaundice, pruritus, dark urine, clay-colored stools, cholangitis

what is the most common location of cholangiocarcinoma

proximal bile duct

what is an MRCP

MRI with visualization of pancreatic and bile ducts

what is the management of a proximal bile duct cholangiocarcinoma

resection with Roux-en-Y

what is the management of distal common bile duct cholangiocarcinoma

Whipple procedure

Biliary Tract Flashcards

(74 cards)