Jaundic And Biliary Disorders CIS

Question 1

Dublin Johnson syndrome

Answer 1

You get the really black liver

• normal AST/ALT and CBC
• galbladder wall thickening

Question 2

What will predispose a pregnant lady who is having cholecystitis to recurrence of symptoms?

Answer 2

Taking oral contraceptives

Question 3

Which blood will give you hyperbilirubinemia?

Answer 3

Sickle cell anemia

-more destruction of RBC’s

Question 4

Faulty excretion of bilirubin

Answer 4

Dublin Johnson

Question 5

Impaired bilirubin storage

Answer 5

Gilbert’s

-the intense one is criggler Najjar

Question 6

Charcot’s triad

Answer 6

For ascending cholangitis

• jaundice
• fever
• RUQ pain

Question 7

Which one is a painless jaundice… They show up and they’re yellow and they don’t know why?

Answer 7

Pancreatic cancer!

Question 8

“Shock liver”

Answer 8

Ischemic hepatitis

-they will be REALLY sick

Question 9

Episodic RUQ pain

Answer 9

Think choledocalithiasis

-diabetes is a risk factor for gallstone production

Question 10

If you see a porcelain gallbladder, what should we worry about

Answer 10

Fucking cancer!

Question 11

What is emphysematous gallbladder

Answer 11

Air around the gallbladder

• in uncontrolled diabetics
• bacterial infection with Th gas-forming organism: C. Perfringes

Question 12

Where do stones get lodged when it hurts like hell in the gallbladder?

Answer 12

The cystic duct!

Question 13

In alcoholic pancreatitis, which is higher, AST or ALT?

Answer 13

AST

-that’s why it’s the weird one

Question 14

What is primary sclerosing cholangitis associated with?

Answer 14

Ulcerative colitis

-remember the pANCA

Question 15

In choledocalithiasis, what pancreatic enzyme is elevated?

Answer 15

Lipase

-stone in the common bile duct…. Backs EVERYTHING up

Question 16

What is ERCP

Answer 16

Endoscopic retrograde cholangiopancreatograhy

Question 17

What is MRCP

Answer 17

Magnetic retrograde cholangiopancreatograhy

Question 18

Where will we have a somatic dyfunction in gallbladder disease

Answer 18

T5-7

Question 19

What gives you a strawberry gallbladder?

Answer 19

Cholesterolosis

Question 20

What is porcelain gallbladder

Answer 20

From chronic cholecystitis

-increased risk of gallbladder cancer

Question 21

What are the 2 kinds of jaundice you can have?

Answer 21

Unconjugated or conjugated

Question 22

Indirect vs. direct bilirubin

Answer 22

indirect is unconjungated

direct is conjugated

Question 23

What are the 2 caused of unconjugated jaundice?

Answer 23

• increase bilirubin production

- impaired bilirubin uptake and storage

Question 24

what can result from increased bilirubin production?

Answer 24

hemolysis

hematoma

Question 25

What can result from impaired bilirubin uptake and storage?

Answer 25

- posthepatitis - Gilbert syndrome - Crigler-Najjar syndrome - drug reaction

Question 26

What are the 3 causes of conjugated jaundice?

Answer 26

- impaired excretion - hepatocellular dysfunction - biliary obstruction

Question 27

What can happen with impaired excretion?

Answer 27

Dubin johnson rotor syndrome choestasis

Question 28

what can happen with hepatocellular dysfunction?

Answer 28

hepatitis/cirrhosis | -infection

Question 29

What can happen with biliary obstruction?

Answer 29

- choledocholithiasis - biliary atresia - pancreatitis - carcinoma of bile duct or pancreas

Question 30

At what level of bilirubin is clinical jaundice seen?

Answer 30

> or = 3 - hemolysis alone rarely elevates bilirubin - white people and mexicans

Question 31

What is ERCP and where does it go?

Answer 31

Endoscopic Retrograde Cholangiopancreatography - down through the stomach into the proximal duodenum - then, a thing comes out that goes into the sphincter of oddi the other way and up the common bile duct

Question 32

What is MRCP?

Answer 32

Magnetic resonance cholangiopancreatography | -it looks like an xray with contrast...

Question 33

What is EUS?

Answer 33

endoscopic ultrasound

Question 34

What will galltones show on Ultrasound?

Answer 34

and ACOUSTIC SHADOW

Question 35

What are some risk factors for gallstones?

Answer 35

female - old - fat - DM - crohn disease... pigment stones - oral contraceptives * Fair, Fat, female, fertile, forty?, family hx

Question 36

What are some protective factors for gallstones?

Answer 36

- low carb - active - COFFEE! - ASA and NSAIDs

Question 37

Acute Cholecystitis

Answer 37

GB wall thickening, pericholecystic fluid, and a sonographic murphy sign

Question 38

complicates of cholecystitis

Answer 38

Perforation, gangrene, abscess, peritonitis, emphysematous choecystitis

Question 39

Choledocholithiasis

Answer 39

common bile duct stone - best seen on ERCP or EUS - can possibly see on US, CT - Can see on MRCP, but usually go on to ERCP since diagnostic and therapeutic

Question 40

What is a potential complication of ERCP?

Answer 40

iatrogenic pancreatitis

Question 41

What was that thing she had in bold on the choledocholithiasis slide?

Answer 41

Bile duct diameter greater than 6mm imaging

Question 42

What does a Porcelain Gallbladder mean?

Answer 42

increased risk for development of gallbladder carcinoma, which has a poor prognosis -incidental calcified lesion... usually asymptomatic

Question 43

What is Charcot's triad

Answer 43

it means ascending cholangitis - Jaundice - Fever - RUQ pain

Question 44

What can cause/ what is reynold's pentad?

Answer 44

the presence of pus in the biliary ducts | -Charcot's triad plus hypotension and confusion

Question 45

What does primary sclerosing cholangitis show on ERCP and MRCP and what does the liver biopsy look like?

Answer 45

- beads on a string | - onion skinning

Question 46

What is PSC associated with?

Answer 46

men - UC!!!! - increased risk of cholangiocarcinoma - same for colon cancer (from UC) - malabsorption of ADEK, esophageal varices, osteoporosis

Question 47

dx PSC

Answer 47

MRCP or ERCP