Gallbladder/Biliary Tract Disorders Flashcards Preview

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Flashcards in Gallbladder/Biliary Tract Disorders Deck (46):
1

Hormone responsible for release of bile into duodenum

CCK

2

Which duct temporarily stores bile in the gallbladder?

cystic duct

3

formation of gallstones (choleliths) which are solid concretions of varying quantities of cholesterol, ca+, and bilirubin which usually form in the GB

cholelithiasis

4

What leads to the formation of cholesterol stones?

Supersaturation of bile with cholesterol and GB hypomotility

5

How do you differentiate between polyp and gallstone on ultrasound?

stone will cast a shadow whereas a polyp will not

6

Treatment for symptomatic cholelithiasis

cholecystectomy

7

stone erodes through GB wall and develops a cholecystoenteric fistula leading to obstruction of narrowest segment of bowel

gallstone ileus

8

Known protective factor for gallstones

statins

9

The presence of gallstones within the CBD. LFT’s (ALT, AST) are elevated, bilirubin and alk phos may be elevated

choledocholithiasis

10

Treatment recommendation of choledolithiasis to prevent acute cholangitis, acute pancreatitis, and hepatic abscesses

removal of all bile duct stones

11

Gold standard for diagnosis of CBD stones, and sphincter of Oddi dysfunction

Endoscopic Retrograde Cholangiopancreatography (ERCP)

12

Detects choledocholithiasis, neoplasms, strictures, biliary dilations. Minimally invansive, but cannot sample bile, test cytology, remove stone

Magnetic resonance cholangiopancreatography (MRCP)

13

A syndrome of RUQ pain that may radiate to right shoulder, fever, and leukocytosis associated with gallbladder inflammation usually caused by cystic duct obstruction. often occurs after fatty meal

acute cholecystitis

14

main cause of acute cholecystitis

impacted gallstone

15

Physical exam manuever that is useful for differentiating pain in the right upper quadrant. positive in cholecystitis, but negative in choledocholithiasis

Murphy's sign

16

The imaging modality of choice for the gallbladder. fast, real-time, non-invasive, and does not utilize ionizing radiation

abdominal ultrasound

17

What does slow uptake of HIDA indicate?

hepatic parenchymal disease

18

What does filling of GB/CBD w/delayed or absent filling of intestine with HIDA indicate?

obstruction of ampulla

19

What does non-visualization of GB w/ filling of the CBD and duodenum with HIDA indicate?

cystic duct obstruction and acute cholecystitis

20

Describe a normal HIDA scan

Early filling of the GB at 15 minutes and complete filling by 25 minutes

21

Preferred treatment for acute cholecystitis

laproscopic cholecystectomy

22

A rare form of acute cholecystitis, which occurs when air appears in the GB wall 2ndry to infection w/ gas forming anerobes. Associated with DM

emphysematous cholecystitis

23

Gender differences between emphysematous cholecystitis and acute cholecystitis

Men are affected twice as commonly as women in emphysematous cholecystitis, where as the reverse is true in most cases of acute cholecystitis

24

RUQ pain that comes and goes, may be referred to right shoulder or right scapula, subsides in 30 minutes. Usually precipitated by a fatty meal. N/V but no fever and WBC normal

chronic cholecystitis

25

Extensive calcium encrustation of the gallbladder wall and blue appearance of gallbladder. common manifestation of chronic cholecystitis

porcelain gallbladder

26

Cancer associated with porcelain gallbladder

adenocarcinoma

27

Primarily cause of acute cholangitis

bacterial infection

28

Most important presdisposing factor for acute cholangitis

biliary obstruction and stasis secondary to biliary calculi (CBD stone) or benign stricture

29

What are the components of Charcot's triad?

RUQ pain, jaundice, and fever/chills

30

life threatening sepsis this is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture

septic cholangitis

31

A chronic inflammatory cholestatic disease. Progressive destruction of bile ducts may progress to cirrhosis, end-stage liver disease. Closely associated with ulcerative colitis. Increased risk of cholangiocarcinoma, gallbladder CA, colon CA and hepatocellular carcinoma

sclerosing cholangtitis

32

How is diagnosis of sclerosing cholangitis made in addition to ANCA?

characteristic multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts on ERCP

33

Treatment for sclerosing cholangitis

Balloon dilation or stenting. Only liver transplant has shown improved survival

34

Slowly progressive autoimmune liver disease. 90% females. Portal inflammation and autoimmune destruction of intrahepatic bile ducts. Leads to cirrhosis and liver failure

primary biliary cirrhosis (PBC)

35

Antibody test that is positive in 90-95% of primary biliary cirrhosis (PBC)

antimitochondrial antibody (AMA)

36

Treatment for primary biliary cirrhosis (PBC) that reduces risk of liver transplantation and death over 4 years, reduces bilirubin, LFT’s, cholesterol and IgM. Delays fibrosis and varices

UDCA (ursodiol)

37

Usually first sign of carcinoma of the biliary tract (Cholangiocarcinoma)

progressive jaundice

38

Prognosis for cholangiocarcinoma

For non-resectable cases, the 5-year survival rate is 0%. Overall median duration of survival is less than 6 months

39

Cancer with High incidence in S America (Chile) maybe due to high prevalence of gallstones and/or salmonella infection

gallbladder cancer

40

Most common histology of gallbladder cancer

adenocarcinoma

41

formed by the union of the pancreatic duct and the common bile duct. specifically located at the major duodenal papilla

ampulla of Vater

42

Where does cancer of the intestinal mucosa most commonly occur (when it does occur)?

ampulla of Vater

43

considered the standard approach for ampullary cancer

Whipple operations

44

Bound to albumin because insoluble in water. Transported into hepatocyte & conjugated

unconjugated bilirubin

45

The most common hereditary cause of increased bilirubin. Produces an elevated level of unconjugated bilirubin in the bloodstream. Caused by a 70-80% reduction in the glucuronidation activity of the UGT1A1 enzyme

Gilbert's syndrome

46

Bilirubin lab results for Gilbert's syndrome

elevated unconjugated bilirubin (indirect) bilirubin, while conjugated (direct) bilirubin is usually WNL