Gallstone ileus, Billiard Cysts, and Cholangiocarcinoma

Question 1

what is a gallstone ileus

Answer 1

mechanical obstruction that results from a stone passing into the bowel through a cholecystoduodenal fistula

blockage at the ileoceal valve

Question 2

symptoms of a gallstone ileus

Answer 2

small bowel obstruction (abdominal distention, discomfort) in an older adult female

no biliary colic

Question 3

Dx of gallstone ileus

Answer 3

X ray of the abdomen to show SBO with pnenumobilia (gas in the biliary tree)

Upper GI biarum constrast will show no contrast in the colon

Question 4

tx of gallstone ileus

Answer 4

laparotomy with stone extraction, closure of the fistula and cholecystectomy

Question 5

Hx/PE of biliary cysts

Answer 5

present before age 10

triad: palpable mass, jaundice , abdominal pain

N/V, fever

Question 6

diagnosis of biliary cysts

Answer 6

labs are typically normal, if there is obstruction in the biliary system there could be transaminitis or hyperbilirubinemia

Question 7

prognosis of biliary cysts

Answer 7

increased risk of cholangiocarcinoma

surgical resection with Roux-en-Y hepaticojejunostomy

Question 8

cholangiocarcinoma arises from

Answer 8

squamous cells of the biliary epithelium

Question 9

intrahepatic cholangiocarcinoma risk factors

Answer 9

history of primary sclerosing cholangitis

fibropolycystic liver disease

chronic liver disease

parasitic exposure to liver flukes

Question 10

symptoms of intrahepatic cholangiocarcinoma

Answer 10

jaundice, pruritis, clay colored stools, dark urine

RUQ pain, weight loss

hyperbilirubinemia, elevated ALP

Question 11

tumor markers in cholangiocarcinoma

Answer 11

CA19-9, CEA, AFP

Question 12

diagnosis of cholangiocarcinoma

Answer 12

US with fine needle aspiration

Question 13

treatment of cholangiocarcinoma

Answer 13

Whipple procedure

pancreaticoduodenectomy

if there is metastasis they will need chemoradiation