Diseases Of The Gallbladder And Bile Ducts Flashcards Preview

Harrison's > Diseases Of The Gallbladder And Bile Ducts > Flashcards

Flashcards in Diseases Of The Gallbladder And Bile Ducts Deck (39):
1

Defective transporter in progressive familial intrahepatic cholestasis type 2 and benign recurrent intrahepatic cholestasis type 1

F1C1

2

An amino phospholipid transferase (flippase) essential for maintaining the lipid assymetry of the canalicular membrane

F1C1

3

Hemitransporters ABCG5/G8 transport the __ and ___.

Cholesterol
Phytosterol

4

Defective transporter in progressive familial intrahepatic cholestasis type 3

MDR3 (ABCB4)

5

Defective ABCG5/G8 will lead to

Sitosterolemia

6

Ablation of all other ATP-dependent transporter functions is a result from a defective___ transporter.

F1C1

7

Mutation in Dubin-Jonhnson syndrome

MRP2 (ABCC2)

8

Inherited form of conjugated hyperbilirubinemia

Dubin-Jonhnson syndrome

9

Defective membrane regulator in cystic fibrosis

CFTR, ABCC7
Located on bile duct epithelial cells

10

Impaired cholangiocellular pH regulation during ductular bile formation and chronic cholestatic liver disease is associated with

Cystic fibrosis
Resulting in biliary cirrhosis

11

Normal bile acid pool size

2-4 grams

12

How many times per day the bile acid pool circulates?

5-10 times

13

Fecal loss of the bile acid is in the range of __

0.2-0.4 g/day

14

Bile salts are actively absorbed at the__

Distal ileum

15

Secondary bile acids:

Deoxycholate
Lithocholate
Ursodeoxycholic acid

16

Most frequently absorbed secondary bile acid

Deoxycholic acid

17

Maximum rate of bile acid synthesis

5 grams per day

18

Release by the intestine to suppress synthesis of bile acids from cholesterol by inhibiting the rate-limiting enzyme P450 7a1 (CYP P7A1)

FGF 19

19

Upregulator of ABCG5/G8

LXR - liver X receptor (an oxysterol sensor)

20

Upregulator of bile salt export pump (ABC B11)

FXR- Farnesoid X receptor (a bile acid sensor)

21

Normal capacity of the gallbladder

30 ml

22

Major factor that controls the evacuation of bile from the gallbladder

CCK

23

Action of CCK: (3)

1. Powerful contraction of the gallbladder
2. Decrease resistance of the sphincter of Oddi
3. Enhanced flow of biliary contents into the duodenum

24

The most important mechanism in bile stone formation

Increased biliary secretion of cholesterol

25

Rate-limiting enzyme of hepatic cholesterol synthesis

HMG-CoA reductase

26

Variables that predict survival in PSC:

1. age
2. serum bilirubin
3. histologic stage
4. splenomegaly

27

Dose of UDCA in sclerosing cholangitis

20 mg/kg

28

Beaded appearance on cholangiography

PSC

29

Disease entities associated with PSC:

IBD
Ig G4-associated cholangitis

30

treatment for IgG4 associated cholangitis

Glucocorticoids

31

Signs and symptoms of PSC :

Biliary obstruction
RUQ pain
Jaundice, pruritus
Acute cholangitis

32

biliary pain, obstructive jaundice, melena

Hemobilia

33

Most common cause of obstructive jaundice

Pancreatic head mass

34

Bile leak or abcess formation in the early postoperative period, biliary obstruction or cholangitis as long as 2 years or more following the inciting trauma

strictures

35

Laboratory picture after relief of obstruction :

aminotransferase returns to normal rapidly
serum bilirubin 1-2 weeks to normalize
alkaline phosphatase level usually falls slowly

36

Acute cholecystitis presenting with back pain or pain to the left of the abdominal line, prolonged vomiting with paralytic ileus and pleural effusion on the left side

Pancreatitis

37

Cholecystitis with S. bilirubin 5-15 mg/dL

CBD stones

38

Cholecystitis with serum bilirubin of 20mg/dL

neoplastic obstruction

39

medical therapy for acute cholecystitis :

NPO
Nasogastric suction
Correct electrolytes and volume depletion
Meperidine or NSAID
IV antibiotic therapy