Path Gallstones and Biliary diseases - mechanical cholestasis Flashcards Preview

GI & Liver Fall 2013 CBD > Path Gallstones and Biliary diseases - mechanical cholestasis > Flashcards

Flashcards in Path Gallstones and Biliary diseases - mechanical cholestasis Deck (22):
1

4 Fs

Female
Fat
Fertile
Fourties

2

Gallstone risks

obesity
age
female sex
fasting
hemolysis
no EtOH

3

EtOH risk factor for cholethiasis?

no

4

Stone types (composition, causes)

brown

black

yellow-white

infectious - Calcium salts and deconjugated bilirubin , cytoeskeleton of bacteria, previous surgery, duodenal diverticula


Pure calcium bilirubinate, calcium copper, mucin glycoprotein. hemolysis.

Cholesterol Ca salts of bilirubin (most common, not seen by xray)

5

enzyme & location for bile acid formation?

insufficiency result?

7alphahydroxylase in hepatocytes is RLS

deficiency -> cholesterol^, stones

6

increased estrogen risk

cholesterol stones

7

GI absorption of bile acids/salts

low absorption in jejunum – active and passive absorption in ileum

8

3 causes of cholesterol bile stones

obesity/hypercholesterolemia
progestrone/birth control
estrogen excess

9

supersaturation of cholesterol - pathalogic or physiologic?

physiologic until stone formation. micelles.

10

delay in gallbladder emptying result?

stone formation

11

4 risk factors for gall stone formation

Defective acidification of gallbladder bile

> pH higher precipitation of calcium salts

Gallbladder stasis can produce increase of mucin and interfere with mechanical emptying

Decreased response to CCK

12

3 risks for brown gall stones

Bacterial infection (duodenum normally sterile - surg & diverticula are risks)

Decreasing biliary secretory IgA

High activity of B-glucuronidase

13

describe biliary tree

RHD, LHD --> HD
HD & CD --> CBD --> PD --> sphincter of odi, ampulla of Vader

14

biliary colic

intermittent pain

15

acute cholecystitis symptoms

abd pain, fever

16

choledocholithiasis w/cholangitis symptoms

abd pain, fever, jaundice

17

biliary pancreatitis symptoms

abdominal pain, increased amylase

18

% of pts w/cholecystectomy w/coledocholithiasis

12-15%

19

emphysematous cholecystitis association

diabetic association

20

Tx of gallstones

sphincterotomy, removal w/balloon

21

2 types of cholestasis & causes

intrahepatic: PBC, drugs, malignancy, etc
extrahepatic: stones, obstruction (surg, primary sclerosing cholangitis, infection, chronic pancreatitis, transplantation stricture)

22

hemobilia (definition, tx)

clots behaving like stones.

Tx is IR or open surg.