Jaundice and Biliary Disorders DSA Flashcards Preview

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Flashcards in Jaundice and Biliary Disorders DSA Deck (27):
1

Jaundice- essentials of diagnosis

-jaundice results from accum of bilirubin in body tissues; the cause may be hepatic or nonhepatic
-hyperbilirubinemia- may be due to abnormalities in the formation, transport, metabolism, or excretion of bilirubin
-persistent mild elevations of aminotransferase levels- most often caused by NAFLD
-evaluation of obstructive jaundice- begins with ultrasonography, and followed by cholangiography

2

Unconjugated hyperbilirubinemia- causes

-inc bilirubin production (hemolytic anemias)
-impaired bilirubin uptake and storage (gilbert syndrome, Crigler-Najjar syndrome)

3

Conjugated hyperbilirubinemia- causes

-hereditary cholestatic syndromes
-hepatocellular dysfxn
-biliary obstruction

4

Gilbert syndrome- cause? type of hyperbilirubinemia, clinical characteristics

-reduced activity of uridine diphosphate glucuronyl transferase
-unconjugated bilirubin
-benign, asymptomatic jaundice

5

Dubin-Johnson syndrome- cause? type of hyperbilirubinemia, clinical characteristics

-reduced excretory fxn of hepatocytes
-conjugated bilirubin
-gallbladder doesnt visualize on oral cholecystography
-liver darkly pigmented!!!

6

Rotor syndrome- cause? type of hyperbilirubinemia, clinical characteristics

-reduced hepatic reuptake of bilirubin conjugates
-conjugated bilirubin
-liver isnt pigmened and gallbladder visualized on oral cholecystography

7

recurrent intrahepatic cholestasis- cause? type of hyperbilirubinemia, clinical characteristics

-cholestasis
-conjugated bilirubin
-jaundice, itching, malaise
-alk phos inc
-cholestasis- liver biopsy

8

intrahepatic cholestasis of pregnancy- cause? type of hyperbilirubinemia, clinical characteristics

-cholestasis
-conjugated bilirubin
-jaundice- 3rd trimester of pregnancy
-recurrence with use of oral contraceptives and subsequent pregnancies

9

symptomatic gallstones- clinical features, lab, diagnosis, teratment

-biliary pain
-normal
-ultrasonography
-laparoscopic cholecystectomy

10

acute cholecystitis- clinical features, lab, diagnosis, teratment

-epigastric or RUQ pain, N/V, fever, murphy sign
-leukocytosis
-ultrasonography, HIDA scan
-antibiotics, laparoscopic cholecystectomy

11

choledocholithiasis

(common bile duct stone)
-asymptomatic or biliary pain, jaundice, fever
-cholestatic liver tests; leukocytosis andp ositive blood cultures in cholangitis; elevated amylase and lipase in pancreatitis
-ultrasonography, EUS, MRCP, ERCP
-endoscopic sphincterotomy and stone extraction

12

Acute Cholecystitis- essentials of diagnosis

-steady, severe pain and tenderness in right hypochondrium or epigastrium
-N/V
-fever and leukocytosis

13

Cholecystitis- caused by

-stone in cystic duct and infl develops

14

Cholecystitis- sx

-attack precipitated by a large/fatty meal- steady pain
-vomiting
-fever
-RUQ tenderness, Murphy sign, m guarding, rebound tenderness

15

Cholecystitis- lab findings

-WBC high
-aminotransferase and alk phos- elevated

16

cholecystitis- imaging

-HIDA scan- for obstructed cystic duct

17

acute cholecystitis- complications

gangrene of the gallbladder
-emphysematous cholecystitis (secondary infection with gas forming organism)

18

Choledocholithiasis and cholangitis- essentials of diagnosis

(common bile duct stones)
-history of biliary pain
-painless jaundice sometimes
-N/V
-cholangitis should be suspected with fever
-stones in bile duct detected by ERCP or EUS!

19

bile duct stone- sx

-freq recurring attacks of RUQ abd pain- severe, lasts for hrs
-chills and fever
-hx of jaundice

20

acute cholangitis- ssx

-pain, fever, jaundice- Charcot triad!!!

21

Reynolds pentad

Charcot triad (pain, fever, jaundice) + altered mental status and hypotension
-suppurative cholangitis- emergency

22

choledocholithiasis- lab findings

-inc in serum aminotransferase levels
-elevation of serum bilirubin
-secondary pancreatitis- amylase elevations

23

choledocholithiasis- imaging

-ERCP- determines cause, location, extent of obstruction

24

Primary Sclerosing Cholangitis- essentials of diagnosis

-most common in men ages 20-50
-assoc with UC
-progressive jaundice, itching, cholestasis features
-diagnosis- characteristic cholangiographic findings
-10% risk of cholangiocarcinoma

25

PSC- dec risk

-smoking in pts who haeve IBD
-coffee

26

PSC- diagnostic findings

-MRCP
-segmental fibrosis of bile ducts with saccular dilatations b/w strictures
-liver biopsy- periductal fibrosis (onion skinning)

27

PSC- complicatoins

cholangiocarcinoma
-CA 19-9 level- suggestive but not diagnostic