Cholestatic disease that isnt gallstones Flashcards
(31 cards)
Rate limiting step of bilirubin elimination?
UDP-glucuronosyltransferase
, the conjugating step
What type of bilirubin would you see elevated in the case of a post hepatic jaundice?
DIRECT bilirubin
Why is bile conjugated by hepatocytes?
Conjugation makes them more hydrophilic which makes them better for excretion
On US you see the following: Pericholecystic fluid, thickened gallbladder wall, and gallstones
Most likely diagnosis
Acute cholecystitis
NO jaundice
POSITIVE murphy’s
RUQ pain
Findings on US:
Pericholecystic fluid, thickened gallbladder wall, gallstones, and a dilated common bile duct
Most likely diagnosis?
Mirizzi’s syndrome, in which a gallstone obstructing the cystic duct (causing cholecystitis) also compresses and collapses the common bile duct (causing choledocholithiasis).
On US: dialated CBD and gallstones in the gall bladder is consistent w/
Choledocolithiasis
If a pt’s bilirubin is primarily conjugated, not unconjugated, is their problem pre, intra, or post hepatic?
conjugated hyperbilirubinemia, so this is a posthepatic problem
predominantly unconjugated hyperbilirubinemia, are you looking for pre, intra, or post hepatic causes?
With predominantly unconjugated hyperbilirubinemia, you look for prehepatic causes—hematoma and hemolysis.
Prehepatic causes of hyperbilirubinemia
Hemolysis or hemtoma
CHronic cholestasis is normally caused by…
cancer, stricture, or an autoimmune cholangiopathies
A lot of bilirubin accumulates (20s, 30s mg/dL) causing jaundice, dark urine, and, in cases of complete obstruction, clay-colored stools. All waste products in the bile accumulate, not just bilirubin. Pruritus is caused by bile acids. Xanthelasmas are caused by excess cholesterol. Unintended weight loss is likely due to cancer.
This is descriptive of…
Chronic cholestasis likely due to cancer, stricture, or one of the autoimmune cholangiopathies
What is the difference in presentation between acute and chronic cholestasis?
Modifiable and nonmodifiable risk factors for pancreatic cancer?
Modifiable risk factors are chronic pancreatitis and smoking cigarettes. Nonmodifiable risk factors are Ashkenazi descent and BRCA2 mutations.
Where are pancreatic carcinomas normally found?
Head of the pancreas
What serologic markers are used to monitor pancreatic cancer course?
CA 19-9 and CEA serologies
**Note that these are not diagnostic
Pancreatic adenocarcinoma demonstrates mutations in ….
Pancreatic adenocarcinoma demonstrates mutations in KRAS (usually the first in the sequence), CDKN2A, and eventually p53.
What surgery do we normally do for early disease state of pancreatic cancer?
Whipple (pancreaticoduodenectomy)
the procedure resects the entire pancreas (except the tail), the entire duodenum, the gallbladder and biliary tree near the cancer, the proximal jejunum, and the pyloric valve and antrum of the stomach. The remaining elements of the digestive unit are attached to the remaining jejunum—pancreaticojejunal, choledocojejunal, and gastrojejunal anastomoses.
pancrearic adenocarcinoma
Whipple procedure
Cholangiocarcinoma
When someone has a positive FIT but a negative colonoscopy, think of ______________________ and get an EGD. Treatment is with a Whipple procedure.
ampullary cancer (Carcinoma of the Hepatopancreatic Ampulla (“of Vater”))
When BOTH cholecystitis and choledocholithiasis are present at the same time, think of …..
Mirizzi
Mirrizzi
What do we mean by “Obstructive Jaundice” ?
Obstructive jaundice is a colloquial term that refers to hyperbilirubinemia (elevated bilirubin in the blood deposits in the skin, causing jaundice, or yellowing of the skin) secondary to cholestasis (slowed or absent flow of bile through the biliary tree).
