Choledocholithiasis, Acute ascending cholangitis, gallstone pancreatitis, Biliary colic

Question 1

Choledocholithiasis is when a ___ inside the ___ blocks the passage of bile

Answer 1

stone

CBD

Question 2

The most common stone (85%) is ___, originating from the ___. Mostly ___ stones

Answer 2

secondary
gallbladder
cholesterol

Question 3

___ stone originates from the ___ tree. They are usually __ pigmented

Answer 3

Primary
biliary
brown

Question 4

direct choledocholithiasis =___

Indirect choledocholithiasis = ____

Answer 4

primary stone

secondary stone

Question 5

The 4 criteria of symptomatic choledocholithiasis are:

Answer 5

RUQ pain
cholestasis (jaundice…)
cholelithiasis
extended CBD (>8 mm)

Question 6

Diagnosing choledocholithiasis is made with ___ showing stones in the ___ and a stone in the ___ leading to proximal blockage

Answer 6

US
gallbladder
CBD

Question 7

Treating choledocholithiasis includes __ followed by elective ___ 6 weeks after.

Answer 7

ERCP

cholecystectomy

Question 8

The two common complications of choledocholithiasis are:

Answer 8

acute pancreatitis

acute ascending cholangitis

Question 9

Acute ascending cholangitis is due to bile ___ and the release of ___ directly to the blood system. It is a severe disease when continues to ___

Answer 9

stasis
bacteria
sepsis

Question 10

Acute ascending cholangitis is usually due to complicated ____ (60%)

Answer 10

choledocholithiasis

Question 11

Acute ascending cholangitis is common in ___ patients

Answer 11

elder

Question 12

The common pathogens in acute ascending cholangitis are: (3)

Answer 12

E.coli
Klebsiella
enterococci

Question 13

50% acute ascending cholangitis will present with the C__ triad, and in 15% with the R__ pentad

Answer 13

Charcot’s

Reynolds

Question 14

What are the 3 stages of treating acute ascending cholangitis:

Answer 14

stabilizing
decompression
cholecystectomy

Question 15

Decompression of acute ascending cholangitis should first include___, not- ___. Successful in ___% of cases.

Answer 15

wide spectrum Abx (ampicillin + gentamycin)
ERCP
80

Question 16

If acute ascending cholangitis patients do not improve under decompression in the first 24 hours, than ___

Answer 16

ERCP

Question 17

Gallstone pancreatitis can be caused by temporary intra ___ pressure increase due to the passage of a biliary ___ in the ___ or ampulla of ____

Answer 17

luminal
stone
CBD
Vater

Question 18

ERCP will be performed in gallstone pancreatitis only if it is ___

Answer 18

severe

Question 19

In order to prevent future pancreatitis events semi elective ____is recommended. It should usually be performed during the same ____

Answer 19

cholecystectomy

hospitalization

Question 20

Biliary colic is when a stone ____ blocks the ___ or if it continues, the ___. There is no ___ present

Answer 20

temporarily
cystic duct
CBD
infection

Question 21

The clinical signs of biliary colic are ___ pain in the __ area. The pain is not ___, and last between ___ hours.

Answer 21

stable
RUQ
colic
0.5-5

Question 22

What is Boas’ sign?

Answer 22

Pain radiating to the right scapula

Question 23

When is it most likely to suffer from biliary colic pain? (2)

Answer 23

after a fatty meal

at night- when lying down

Question 24

Biliary colic pain usually appear with __ /__and ___

Answer 24

nausea
vomiting
sweating

Question 25

Biliary colic pain does not come with ___, ___, or ___.

Answer 25

fever leukocytosis jaundice

Question 26

What is the meaning of biliary colic pain together with cholestatic lab?

Answer 26

choledocholithiasis (the stone is stuck in the CBD)

Question 27

Diagnosing biliary colic is made with ___ showing __- but no ___ in the gallbladder (unlike in ___)

Answer 27

US gallstone inflammation acute cholecystitis