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Hepatobiliary and pancreatic disorders > Goljan Gallbladder and Biliary Tract disease > Flashcards

Goljan Gallbladder and Biliary Tract disease Flashcards

(53 cards)

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1
Q

Epidemiology of choledochal cyst

A

most common cyst in biliary tract in children < 10yo

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2
Q

clinical findings of choledochal cyst

A

abdominal pain w/ persistent or intermittent jaundice;

increased risk of cholelithiasis, cholangiocarcinoma, cirrhosis

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3
Q

Diagnosis of choledochal cyst

A

ultrasound is gold standard;

endoscopic retrograde cholangiopancreatography (ERCP => ID’s intra- and extrahepatic cysts along w/ sites of obstruction

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4
Q

Tx of choledochal cyst

A

surgery

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5
Q

Define Caroli disease

A

AD (adult) and AR (kids) types;
segmental dilatation of intrahepatic bile ducts;
portal tract fibrosis

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6
Q

clinical findings of Caroli disease

A

assoc w/ polycystic kidney disease;
increased risk of cholangioCA;
increased risk of intrahepatic cholelithiasis, cholangitis, hepatic abscesses, portal HTN

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7
Q

Tx of Caroli disease

A

surgical resection of involved lobe;

liver transplantation

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8
Q

MC malignancy of bile ducts

A

cholangioCA

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9
Q

causes of cholangioCA

A

primary sclerosing cholangitis;
Clonorchis sinensis (chinese liver fluke);
Thorotrast (thorium dioxide);
Choledochal cyst, Caroli disease

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10
Q

locations of cholangioCA

A

ampulla or common bile duct (MC);
junction of R/L hepatic duct => Klatskin tumor;
intrahepatic

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11
Q

clinical finding of cholangioCA

A 
obstructive jaundice;
palpable gallbladder (Courvoisier's sign);
hepatomegaly
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12
Q

Diagnosis of cholangioCA

A

ultrasound;

ERCP

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13
Q

Tx for cholangioCA

A

surgery

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14
Q

Bile components

A 
bile salts/acids (67%)
phospholipid;
protein;
free CH;
conjugated bilirubin;
water, electrolytes, bicarbonate
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15
Q

What is the purpose of bile salts/acids?

A

hepatic product of CH metabolism;
water soluble;
detergent action renders CH soluble in bile

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16
Q

What does phospholipid serve as in bile?

A

mainly lecithin;
hydrophobic;
solubilizes CH in bile

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17
Q

What are the types of gallstones?

A 
cholesterol stones (75%);
pigment stones (black, brown)
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18
Q

Describe cholesterol stones

A

stones of mixed composition typically radiolucent;

stones contain CH, Ca+ carbonate, some bilirubin pigment => radiopaque if w/ CaHCO3;

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19
Q

What are black pigment stones a sign of?

A

chronic extravascular hemolytic anemia (sickle cell anemia, hereditary spherocytosis);
excess bilirubin in bile produces Ca+ bilirubinate

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20
Q

What are the brown pigment stones a sign of?

A

sign of infection in common bile duct (CBD);

commonly in Asians

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21
Q

pathogenesis of cholesterol stones

A

supersaturation of bile w/ cholesterol;

decreased bile salts/acids (normally solubilize cholesterol in bile)

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22
Q

Risk factors for cholesterol stones

Study These Flashcards
A 
female, OCP
>40;
obesity (cholesterol increased in bile);
rapid weight loss;
use of lipid lowering drugs;
Native americans
23
Q

complications assoc w/ stones

Study These Flashcards
A

cholecystitis (MC);
CBD obstruction;
Gallbladder cancer;
acute pancreatitis

24
Q

Epidemiology of acute cholecystitis

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A

women > men
50-60 yo;
native americans;
assoc w/ gallstones in 95% of cases

25
describe stage 1 development of acute cholecystitis
stone lodges in cystic duct; midepigastric colicky pain occurs from GB contraction against cystic duct; N/V WITHOUT pain relief
26
How does a stone get lodged in cystic duct in acute cholecystitis?
stimulus of food causes gallbladder contraction => forces into cystic duct
27
describe stage 2 development of acute cholecystitis
stone becomes impacted in cystic duct; mucus accumulates behind obstruction; chemical irritation of mucosa; bacterial overgrowth (no invasion) of E. coli; pain shifts to RUQ => dull, continuous aching pain => pain radiation to right scapular/shoulder
28
describe stage 3 of acute cholecystitis
bacterial invasion of GB wall; localized peritonitis w/ rebound tenderness; positive Murphy sign; absolute neutrophilic leukocytosis; attack subsides if stone falls out of cystic duct
29
describe stage 4 of acute cholecystitis
perforation; | wall tension from GB distention compresses lumens of intramural vessels => gangrenous necrosis
30
What are diseases NOT associated w/ stones but may cause acute cholecystitis?
AIDS (CMV or cryptosporidium infection); | severe volume depletion
31
clinical findings in acute cholecystitis
``` fever; appropriate stage related findings; vomiting (75%); radiation of pain to right scapula/shoulder; Murphy sign; Jaundice (common bile duct stone); palpable gallbladder ```
32
Lab findings w/ acute cholecystitis
absolute neutrophilic leukocytosis w/ L shift and WBC > 12,000 cells/mm^3; increased AST/ALP; increased serum amylase and lipase assoc w/ pancreatitis; increased serum bilirubin > 4mg/dL (CBD stone)
33
What type of stone does estrogen cause?
Cholesterol
34
how does estrogen increase cholesterol stone formation?
increases HDL synthesis which transports cholesterol from peripheral tissue to liver for excretion in bile; upregulates LDL receptor synthesis in hepatocytes and increases HMG-CoA reductase activity which is rate-limiting enzyme in CH synthesis
35
What are the tests to identify stones?
ultrasound (gold standard); Plain film (Xray); hepatobiliary iminodiacetic acid radionuclide scan or HIDA scan
36
What is sensitive and not sensitive to find on ultrasound for stones?
stones > 12mm in diameter; detects sludge; evaluates GB wall thickness; NOT effective in ID'ing CBD stones
37
what is the downside of Xray when looking for stones?
only 20% are radioopaque
38
Where is a HIDA scan good for finding stones?
stones in cystic duct=> no visualization of GB; CBD stones => no tracer in duodenum
39
what are indications for CBD exploration?
jaundice; CBD dilatation > 12mm no stones in GB; acute pancreatitis
40
Tx for acute cholecystitis
cholecystectomy; ERCP w/ sphincterotomy to extract CBD stone Meperidine for pain => NO morphine as will cause sphincter of Oddi to contract and worsen pain; piperacillin-tazobactam
41
Epidemiology of chronic cholecystitis
most common symptomatic disorder of GB
42
pathogenesis for chronic cholecystitis
``` cholelithiasis w/ repeated attacks of minor inflammation; chemical inflammation (infection uncommon); ```
43
clinical findings in chronic cholecystitis
severe, persistent pain 12hr post-prandially in evening; pain radiates into right scapular area; recurrent epigastric distress, belching, bloating
44
Tx for chronic cholecystitis
laparoscopic cholecystectomy
45
define cholesterolosis and clinical significance
excess cholesterol in bile; | NO clinical significance
46
Why does cholesterolosis have a distinct gross appearance?
cholesterol deposits in macs which cause a yellow, speckled mucosal surface of gallbladder
47
define hydrops of gallbladder
chronic obstruction of cystic duct leading to GB distention w/ atrophy of mucosa/muscle => clear secretions
48
Tx for hydrops of gallbladder
surgery
49
epidemiology of gallbladder adenocarcinoma
elderly women; | poor Px
50
pathogenesis of gallbladder adenocarcinoma
cholelithiasis (95%); | porcelain gallbladder
51
describe a porcelain gallbladder assoc w/ gallbladder adenocarcinoma. What should be done?
gallbladder w/ dystrophic calcification; | immediate surgical removal due to 50% risk for cancer progression
52
Tx of gallbladder adenocarcinoma
surgery
53
Why is gallbladder adenocarcinoma Px so low?
most have locally invaded liver or porta hepatis at finding; | 5yr survival rate < 2%

Hepatobiliary and pancreatic disorders (7 decks)

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