Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > Biliary Tract Disease > Flashcards

Biliary Tract Disease Flashcards

(136 cards)

Start Studying
1
Q

What demographics have a high rate of cholesterol gallstones?

A

Mexican Americans and several American Indian tribes, particularly the Pima Indians in the Southwest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for biliary tract disease?

A 
Women affected 3x more than men
Prevalence increases with age
Clusters in families
Obesity 
Multi-parity 
High-dose estrogen OCPs
Rapid weight loss
Prolonged TPN
Pregnancy is thought to predispose one to gallstones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Between meals, sphincter of Oddi contracts and diverts bile into:

A

Gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What stimulates contraction of the gallbladder and relaxation of the sphincter of Oddi in response to fats in duodenum?

A

Cholecystokinin (CCK)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is bile composed of?

A

cholesterol, bile salts, and phospholipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common type of gallstone?

A

Mixed stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a mixed stone?

A

High proportion of cholesterol with bile acids and lecethin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the types of gallstones?

A 
Mixed
Cholesterol
Black
Brown 
(Sludge)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are black stones indicative of?

A

Hemolytic disease and cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are brown stones and where are they usually found?

A

Infected bile

Usually present in the CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where do most Choledocholethiasis come from?

A

Gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are primary common bile duct stones?

A

Formed in the CBD itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are primary CBD stones usually from?

A

Stasis or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which imaging is the standard of care for gallstones?

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the recommended treatment for asymptomatic gallstones for both diabetics and non-diabetics?

A

Observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cirrhosis leads to an increased incidence of what?

A

Gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the recommended treatment for a patient with asymptomatic gallstones in a pt with cirrhosis?

A

Careful observation

Early intervention for Child’s A & B when symptoms develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the recommended treatment for a pt with hemolytic anemia and asymptomatic gallstones?

A

Cholecystectomy at time of splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the recommended treatment for a pt with Somatostatinoma and asymptomatic gallstones?

A

Cholecystectomy recommended at time of tumor resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the recommended treatment for a pt undergoing bariatric surgury and asymptomatic gallstones?

A

Likely to develop symptoms in post op period

Adding cholecystectomy to procedure adds minimal M & M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the recommended treatment for a pt with porcelain gallbladder and asymptomatic gallstones?

A

Cholecystectomy

Porcelain gallbladder associated with 20-60% cancer risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is biliary colic caused by?

A

a stone that lodges in the cystic duct causing an obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why do symptoms resolve with biliary colic?

A

The stone does not stay lodged and when it becomes un-lodged, the symptoms resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What cause pain in biliary colic?

A

distention of the gallbladder, not inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Where is the pain located with biliary colic?
RUQ, less likely epigastric. May go to back. May radiate to right shoulder
26
What are the characteristics of pain with biliary colic?
Visceral - dull, aching Severe Increases in severity, plateaus for several hours, then decreases
27
What symptoms are associated with biliary colic?
N/V
28
What is the duration of pain with biliary colic?
1 – 4 hours
29
What are precipitating factors of biliary colic?
Large fatty meals
30
What are alleviating factors of biliary colic?
None
31
What will the abdominal exam show with biliary colic?
Soft, ND +/- tenderness
32
What will be on labs with biliary colic?
CBC w/diff – nl | LFTs - nl
33
What will the ultrasound show with biliary colic?
gallstones w/o GB wall thickening or pericholocystic fluid and nl CBD
34
What is the recommended treatment for biliary colic?
Elective cholecystectomy | Less complications, shorter hospital stay if operation done electively rather than at time of acute cholecystitis
35
When should gallbladder dyskinesia be suspected?
In pts with sx suggestive of biliary colic but no stones
36
What imaging is used for gallbladder dyskinesia?
Nuclear cholescintigraphy (HIDA, PPIDA, radionuclide biliary scan) with CCK stimulation
37
What is a normal gallbladder ejection fraction?
Normal > 35%
38
What causes acute cholecystitis?
Persistent stone impaction in the cystic duct causes the gallbladder to become distended and progressively inflamed
39
How does acute cholecystitis present?
pain of biliary colic that persists and worsens
40
What have most acute cholecystitis patients experienced in the past?
Biliary colic
41
Where is the pain located with acute cholecystitis?
RUQ or epigastric. May go to back. May radiate to right shoulder
42
What are the characteristics of pain with acute cholecystitis?
Sharp and better localized. Constant and severe
43
What are the associated sx of acute cholecystitis?
N/V, fever, chills
44
What is the duration of pain in acute cholecystitis?
3 – 4 hours to several days
45
What are the precipitating factors of acute cholecystitis?
Large fatty meals
46
What are the alleviating factors of acute cholecystitis?
None
47
What vital signs are associated with acute cholecystitis?
+/- fever, +/- tachycardia, +/- hypotension
48
What will the abdominal exam show with acute cholecystitis?
Soft, tender in RUQ May have localized guarding or rebound + Murphey’s sign Mass RUQ in 20% - tender!
49
What will labs show for acute cholecystitis?
CBC w/diff - +/- leukocytosis with left shift | LFTs – Most likely normal. You can have mild elevation of AST (< 1.5)
50
What will US show for acute cholecystitis?
``` US - gallstones w/ distended GB GB wall thickening pericholocystic fluid US Murphy’s sign Nl CBD ```
51
What is the tx for acute cholecystitis?
``` NPO IVF IV ABX IV pain meds Anti-emetics Early cholecystectomy (within a few days of symptom onset) ```
52
What bacteria is seen with acute cholecystitis?
E. coli, K. pneumonia, S. faecalis | Gram – aerobes and enterococcus
53
What is the ddx with acute cholecystitis?
Acute hepatitis Acute pancreatitis Perforated peptic ulcer Acute appendicitis
54
Acalculous cholecystitis is seen in what demographic?
Usually in a patient who is acutely ill for other reasons | Common in ICU patients
55
What will US show for acalculus cholecystitis?
no stones but other findings of acute cholecystitis
56
What imaging besides US should be ordered for acalculus cholecystitis?
Nuclear cholescintigraphy (HIDA, PPIDA, radionuclide biliary scan)
57
What is the tx for acalculuous cholecystitis?
Cholecystectomy or cholecystectomy tube
58
What is an empyema?
Bacterial proliferation in the obstructed GB
59
What signs and sx are seen with an empyema?
Marked fever and leukocytosis
60
What is the tx for an empyema?
Early decompression
61
What are the sx of gallbladder perforation?
High fever, chills, rigors, septic shock
62
What causes an Emphysematous cholecystitis?
Gas-forming organism
63
What does an Emphysematous cholecystitis have a higher risk of?
Gangrene
64
What condition predisposes a pt to have Emphysematous cholecystitis?
DM
65
What is the treatment for Emphysematous cholecystitis?
Emergency cholecystectomy after stabilization
66
What is Hydrops (mucocele) of the gallbladder?
Over-distended gallbladder with mucoid or clear and watery content From gallstone disease Non-inflammatory From gallstone disease
67
How does Hydrops (mucocele) of the gallbladder present?
Presents similar to biliary colic but sx last longer and palpable minimally tender GB - sometimes to pelvis
68
What is the gold standard cholecystectomy surgery?
Laperoscopic cholecystectomy
69
What are the risks of laperoscopic cholecystectomy?
``` Adhesions poor visualization of critical structures hemorrhage bile duct injury injury to another organ ```
70
What is the positioning of the patient and surgeons for Laperoscopic cholecystectomy?
pt supine with arms out | Surgeon on the left, assistant on the right
71
What are intraoperative cholangiograms used for?
Identify CBD stones and delineate biliary anatomy | Occult CBD stones exist in 4-10% of pts
72
What is the triangle of Calot?
Usual location of the cystic artery
73
What structures form the triangle of Calot?
Common hepatic duct, cystic duct, edge of liver
74
What are the complications of a lap chole?
``` CBD injury – rare, serious complication Bowel injury Bleeding Infection Bile leak ```
75
What is the duct of Luschka?
tiny ducts that drain from the liver into the body of the GB, can cause bile leak
76
What are the two structures that could leak bile?
Duct of Luschka | Cystic duct stump
77
How is a bile leak evaluated?
Labs and PIPIDA scan +/- other imaging to look for fluid collection
78
How is a bile leak treated?
Percutaneous drainage or ERCP stent placement or combination or surgical drain placement
79
What is the post-cholecystectomy syndrome?
Epigastric or RUQ pain after cholecystectomy 40% of patients have minor GI complaints Gas, bloating, abdominal pain, or diarrhea
80
What is most often the cause of persistent post-cholecystectomy syndrome?
Wrong preoperative dx
81
What causes choledocholethiasis?
Common bile duct stones
82
Where do most stones originate in choledocholethiasis?
GB and migrate to CBD
83
What physical sign is consistent with choledocholethiasis?
Intermittent jaundice
84
What can choledocholethiasis progress to?
Cholangitis (inflammation of bile ducts)
85
What other signs/sx are associated with the jaundice caused by choledocholethiasis?
Puritis, clay colored stools, tea colored urine
86
What is the location of pain with choledocholethiasis?
RUQ. Could be intermittent. Could have no pain at all
87
What will vitals show for a pt with choledocholethiasis?
Normal
88
What will the abdominal exam show for a pt with choledocholethiasis?
Soft NTND. May be tender
89
What will labs show for choledocholethiasis?
CBC w/diff – usually normal LFTs - elevated T. bili, mostly direct, marked elevation of alk phos and GGT. Mild elevation of AST and ALT. Amylase and lipase - normal
90
What will US show for choledocholethiasis?
US - gallstones +/- CBD stone. Dilated intra- and extra- hepatic ducts. Dilated CBD >6-8mm.
91
What test other than US should be ordered for choledocholethiasis?
Cholangiography (MRCP or ERCP or IOC)
92
What are the advantages/disadvantages of MRCP?
less invasive. Can’t be therapeutic
93
What are the advantages/disadvantages of ERCP?
Invasive, but can be therapeutic
94
What is the ultimate treatment for CBD stones?
Lap chole prevents future CBD stones
95
How are cbd stones treated if they pass on their own?
Wait to pass then do lap chole
96
How are CBD stones treated if they will not pass?
ERCP with sphinterotomy and stone extraction
97
What is an alternative to ERCP for finding a CBD stone?
Surgical CBD exploration laparoscopically
98
What is acute ascending cholangitis?
Septic process of the biliary tree | Combination of inflammation from bacteria in the bile and some degree of biliary obstruction
99
What is the most common cause of acute ascending cholangitis?
CBD stones or benign strictures
100
What are some other causes of acute ascending cholangitis?
``` malignancy internal biliary stents pancreatitis Mirizzi’s syndrome viral infection parasitic infection duodenal ulcer ```
101
What is the ddx for acute ascending cholangitis?
Acute hepatitis Acute pancreatitis Perforated peptic ulcer Acute appendicitis
102
Where is the location of pain for acute ascending cholangitis?
RUQ or epigastric. May go to back. May radiate to right shoulder
103
What are the characteristics of the pain for acute ascending cholangitis?
Visceral - dull, aching. Steady and severe
104
What are the associated sx with acute ascending cholangitis?
N/V/F/C, yellowing of the eyes and skin, clay colored stools and tea colored urine
105
What will general survey show for acute ascending cholangitis?
Uncomfortable, juandice, may have confusion, may be diaphoretic and appear very ill (septic)
106
What will vitals show for acute ascending cholangitis?
Fever, tachycardia, hypotension if suppurative
107
What will the abdominal exam show for acute ascending cholangitis?
RUQ tenderness, may have localized guarding and rebound
108
What will labs show for acute ascending cholangitis?
CBC w/diff - leukocytosis with left shift LFTs - elevated T. bili, mostly direct, marked elevation of alk phos and GGT. Mild elevation of AST and ALT Amylase and lipase - normal
109
What will US show for acute ascending cholangitis?
US - gallstones +/- CBD stone. Dilated intra- and extra- hepatic ducts. Dilated CBD >6-8mm
110
What is Charcot's Triad for acute ascending cholangitis?
Fever Jaundice RUQ pain Occurs in only 20% of pts
111
What is Reynold’s Pentad for acute SUPPURATIVE cholangitis?
Charcot’s triad + Mental status changes (Delirium) Hypotension (Shock)
112
What is the tx for acute ascending cholangitis?
``` NPO IVFs Broad-spectrum antibiotics Biliary decompression Drainage can be endoscopic – ERCP (GI) or percutaneous transhepatic - PTC (radiologist) ```
113
What is the tx for acute ascending cholangitis if the cause is due to stones?
Lap chole
114
What is a gallstone ileus?
When a large gallstone (2 cm) causes a SBO by lodging in the distal ileus
115
How does a gallstone get into the small bowel?
Erodes through the gallbladder directly into the small intestine creating a fistula The stone passes along the small bowel and creates an obstruction usually at the distal ileum
116
What demographic usually gets a gallstone ileus?
Elderly
117
What is the imaging of choice for a gallstone ileus and what will it show?
Plain films of the abdomen – SBO with intrahepatic biliary air and a calcification in the RLQ
118
What is the treatment for a gallstone ileus?
NGT IVF Enterotomy with stone extraction +/- cholecystectomy and fistula repair
119
What demographic is at highest risk for galbladder cancer?
American Indians and Hispanics | women>men
120
What are the risk factors for gallbladder cancer?
``` cholesterol gallstones single large gallstone calcified GB (porcelain) biliary Salmonella typhi infection biliary polyps > 1 cm ```
121
What are the sx of early gallbladder cancer?
asymptomatic or that of biliary colic
122
What are the sx of advanced GB cancer?
Vague RUQ pain, weight loss and malaise Jaundice in 50% Hard mass in RUQ – may be non-tender
123
What is the only cure for GB cancer?
complete surgical removal Cholecystectomy alone if only at peritoneal surface (rare) En bloc resection of the gallbladder, liver bed, and lymph nodes Formal liver resection
124
What is the 5 year survival rate for GB cancer?
<5%
125
What is Cholangiocarcinoma?
Malignancy of the biliary duct system | Intrahepatic, extrahepatic (perihilar), and distal extrahepatic
126
In what demographic is Cholangiocarcinoma seen?
Equal among sexes | 50 – 70 year old
127
How does cholangiocarcinoma progress?
Slow growing but advance locally and are usually non-resectable at diagnosis
128
What are the most common tumors seen in cholangiocarcinoma and where are they located?
Klatskin (perihilar) tumors | At the bifurcation of right and left hepatic ducts
129
What are the risk factors for cholangiocarcinoma?
UC Sclerosing cholangitis Choledochal cysts Parasitic disease
130
What are the sx of cholangiocarcinoma?
``` Most common sx is jaundice (progressive) Pruritis Weight loss Abdominal pain Cholangitis ```
131
What will the physical show for cholangiocarcinoma?
Yellow Hepatomegaly May have Curvoisier’s sign
132
What is Curvoisier's sign?
Enlarged palpable gallbladder in patient with jaundice. Dilation of GB with thin walls
133
What will show on labs for cholangiocarcinoma?
same as choledocholethiasis except bilirubin can get much higher
134
What imaging can be used to evaluate cholangiocarcinoma?
US, CT, MRI | PTC, ERCP, EUS – can biopsy
135
What is the treatment for cholangiocarcinoma?
Resection if cure is a possibility | Bypass or stent for symptom relief
136
What is the 5 year survival rate of cholangiocarcinoma with resection?
5-25%

Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions