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From Flashcardlet > Med Biliary Tract > Flashcards

Med Biliary Tract Flashcards

0
Q

Composed of pure calcium bilirubinate

Common in pts with cirrhosis and chronic hemolytic states

A

Black pigment stones

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1
Q

Cholesterol stones

A

Most common type of gallstone

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2
Q

Composed of calcium salts of unconjugated bilirubin

Associated with infection

A

Brown pigment stones

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3
Q

Mgt for recurrent cholecytitis or biliary obstruction

A

Cholecystectomy

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4
Q

Stone in cystic duct that compresses CBD

A

Mirrizi’s syndrome

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5
Q

Stone eroding through gallbladder into duodenum

A

Gallstone ileus

Cholecystenteric fistula

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6
Q

Long standing cholelithiasis is a predisposing factor to?

A

Gallbladder Carcinoma

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7
Q

Principal imaging modality for gallstone

A

Sonography

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8
Q

Goldstandard for diagnosing gallstones within gallbladder

A

Sonography

  • acoustic shadow
  • detects stones as small as 2mm
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9
Q

Positive predictive value of >90% for acute cholecystitis if gallstone is present

A

Sonographic Murphy’s sign

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10
Q

Medical dissolution of stone or lithotripsy

A

Oral cholecytography

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11
Q

Radionuclide-based imaging test of gallbladder and biliary tract

A

Cholescintigraphy

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12
Q

Gold standard for choledocholithiasis

A

Endoscopic retrograde cholangiopancreatiography (ERCP)

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13
Q

Main use:

Detection of complications of gallstones

A

CT and MRI

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14
Q

Most common clinical manifestation of gallstone disease

A

Biliary colic

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15
Q

Pain precipitated by fatty meal
Pain that is steady (not intermittent)
Gradually increases (15mins to 1hr) then plateaus for 1hr then goes away
More common in epigastrium

A

Biliary colic

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16
Q

Pain lasting more than 6hours

A

Acute cholecystitis

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17
Q

First imaging modality preferred for biliary colic

A

Sonography

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18
Q

Treatment for biliary colic

A

Cholecystectomy

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19
Q

Most frequent complication of gallstone disease

Due to inflammation of gallbladder wall

A

Acute cholecystitis

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20
Q

Examination of aspirated duodenal bile

A

Meltzer-Lyon test

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21
Q

Location of pain in cholelithiasis

A

Epigastric

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22
Q

Localization of pain in acute cholecytitis

A

RUQ

23
Q

Triad of:
Fever (low grade)
Pain (RUQ)
Jaundice (mild)

A

Acute cholecystitis

Charcot’s triad

24
Q

Triad of:
Fever (high grade)
Pain
Jaundice

A

Cholangitis

Charcot’s triad

25
Q

Definitive treatment of acute cholecystitis

A

Cholecystectomy

26
Q

Stones in CBD

A

Choledocholithiasis

27
Q

T or F?

Cholesterol stones only form in the gallbladder

A

True

28
Q

T or F?

Black pigment stones form in the gallbladder but rarely migrate to CBD

A

True

29
Q

T or F?

Brown pigment stones form de novo in CBD

A

True

30
Q

T or F?

Brown pigment stones form due to bacterial action?

A

True

31
Q

T or F?

Rise in ALP is proportional to severity of obstruction

A

False

32
Q

T or F?

Rise in bilirubin is proportional to degree of obstruction

A

True

33
Q

Suggests passage of CBD stone into duodenum

A

Transient spikes of transaminases or amylase

34
Q

T or F?

Cholescintigraphy can exclude acute cholecystitis

A

True

35
Q

T or F?

Sonography can exclude choledocholithiasis

A

False

36
Q

Gold standard for choledocholithiasis

A

ERCP

37
Q

Diagnosis in setting of dilated intrahepatic ducts

A

Percutaneous transhepatic cholangiography

PTC

38
Q

Treatment for choledocholithiasis

A

ERCP

39
Q

T or F?

Bile duct obstruction is sufficient to cause cholangitis

A

False

Bile duct obstruction is necessary but not sufficient

40
Q

Result of obstruction of a bile duct that already contains bacteria

A

Cholangitis

41
Q

Reynold’s pentad observed in what bile duct disease?

A

Cholangitis

42
Q

Treatment for cholangitis

A

Antibiotics with G (-) and anaerobic coverage

43
Q

Improvement for antibiotic treatment of cholangitis should be observed by what time?

A

6-12 hours

44
Q

Treatment of choice for cholangitis

A

ERCP with stone extraction or decompression via T-tube

But infection must be controlled and subsided before operation can be done

45
Q

Gallstone complication involving infection of gallbladder wall by gas forming organisms

A

Emphysematous cholecystitis

46
Q

Gallstone disease complication that is prone to rupture and peritonitis

A

Emphysematous cholecystitis

47
Q

Stones eroding in wall of gallbladder (neck) and into a hollow viscus

A 
Cholecystenteric fistula
(Duodenum, hepatic flexure, stomach, jejunum)
48
Q

What do you se upon diagnostic imaging of emphysematous cholecystitis?

A

Pockets of gas in area of gallbladder fossa

49
Q

Treatment for emphysematous cholecystitis

A 
Anaerobic coverage
Early cholecystectomy (ASAP)
50
Q

Common in diabetics and old men without gall stones with atherosclerosis of cystic artery resulting in ischemia

A

Emphysematous cholecystitis

51
Q

What is observed upon radiographic diagnosis of cholecystenteric fistula?

A

Pneumobilia (air in biliary tree from fistula with hollow viscus)
(Confirmed with barium contrast of UGI or LGI)

52
Q

Size of stone that may cause small bowel obstruction in elderly women in cholecystenteric fistula

A

> 25mm

Most commonly in ileocecal area

53
Q

Impacted stone in neck of gallbladder or in cystic duct that COMPRESSES THE COMMON BILE DUCT EXTRINSICALLY

A

Mirrizzi’s syndrome

54
Q

diagnostic modalities for Mirrizzi’s syndrome

A
  1. Open cholecystectomy

2. Endoscopic stenting with laparoscopic cholecystectomy

55
Q

Intramural calcification of gallbladder wall

High incidence of carcinoma

A

Porcelain bladder

56
Q

Treat pment for porcelain gallbladder

A

Prophylactic cholecystectomy

From Flashcardlet (33 decks)

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