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Flashcards in test #37 4.27 Deck (153):
1

where are B1 receptors located

cardiac tissue and renal juxtaglomerular cells

2

main effect of beta blockers on blood pressure?

reduced renin release from juxtaglomerular cells in kidney

3

three presentations of ascension of gonorrhea / chlamydia..

1. PID: purulent cervical discharge and cervical motion tenderness

2. salpingitis & tubo-ovarian abscess

3. peritoneal inflammation, including Fitz-Hugh-Curtis syndrome -- from inflammation of hepatic capsule

4

Fitz-Hugh-capsule

associated w/ PID (gonorrhea / chlamydia ascension).

infection of liver capsule and "violin-string" adhesions of peritoneum to liver

5

two options for treating chlamydia

azithromycin or doxycycline

6

how long should people attempt to conceive before seeking medical intervention?

at least 1 year

7

when does advanced maternal age become a factor in ability to conceive

after 35 y/o
(aging of oocytes & decreased ovarian reserve of oocytes)

8

normal thickness of right ventricle? left?

right: 3-4mm
left: 1cm

9

definition of cor pulmonale

right ventricular hypertrophy caused by pulmonary HTN

(w/ or w/o congestive heart failure)

10

most common cause of pulmonary HTN

obliteration of segments of pulmonary vasculature by COPD

11

primary pulmonary HTN

young women, between 20-40y.o

mutation in BMPR2.

can no longer limit progressive proliferation of endothelial, smooth muscle, and intimal cells.

striking medial hypertrophy or arterioles and small arteries, as well as concentric laminar intimal fibrosis

12

what does the hemiazygous drain

blood from posterior walls of the thorax and abdomen

azygous + hemiazygous + accessory hemiazygous provide alternate path for blood to return to HEART, bypassing IVC

13

right gonadal vein & adrenal vein & renal vein drain? left?

right gonadal, renal, and adrenal drain directly into IVC

left gonadal and adrenal drain into RENAL VEIN, which passes between aorta & SMA into IVC

14

heteroplasmy refers to..

condition of having different organellar genomes within a single cell (mutated and wild-type)

15

MELAS

mitochondrial encephalopathy, lactic acidosis, stroke-like symptoms

mitochondrial disease (heteroplasmy)

16

Leber hereditary optic neuropathy

mitochondrial disease (heteroplasmy)

17

MERRF

myoclonic epilepsy, ragged red fibers (gomori trichrome stain)

18

Mccune-Albright syndrome inheritence

precocious puberty
polyostotic fibrous dysplasia
unilateral cafe au lait spot

mosaicism: post-zygotic mutation in somatic cells in GNAS-1

19

when a patient has hypertension, hyperlipidemia, coronary artery bypass surgery, and carotid endartectomy history.. suggests he suffers from..

generalized atherosclerosis

20

presentation of chronic mesenteric ischemia? due to? light microscopy

atherosclerotic narrowing of celiac trunk, SMA, and IMA

1. epigastric or periumbilical abdominal pain (30-60min after food intake)
-- atherosclerotic arteries not able to dilate in response to increased blood flow requirements during digestion/absorption of food.

2. weight loss: hurts so bad, avoid eating.

pain out of proportion to exam! physical exam will seem bland

light microscopy: hypoperfused areas show mucosal atrophy and loss of villi. atherosclerotic plaques.

[similar pathogenesis to angina pectoris]

21

epigastric pain 30-40min post meal. weight loss b/c hurts so much to eat. in hyperlipidemic person.

chronic mesenteric ischemia

22

bony matrix consists of..

1. inorganic: hydroxyapatite crystals
2. organic: type 1 collagen

23

osteogenesis imperfecta has an abnormality in which part of bone

bony MATRIX
supposed to give flexibility

autosomal dominant

24

complexity of eukaryotic genome due to..

presence of large number of non-coding DNA regions between coding regions (not just size)

25

glucokinase is located in..

pancreatic B cells and liver

26

glucokinase vs. hexokinase

glucokinase (pancreatic beta cell): higher Km, less sensitive to allosteric inhibition
[less affinity for glucose than hexokinase]

27

glucokinase deficiency in beta pancreatic cells

impaired glucose sensor in beta-pancreatic cells.

beta cells can't convert glucose -> ATP -> close K+ channels -> depol and release INSULIN

---> insulin deficiency --> diabetes!

28

inactivating mutations in glucokinase can be exacerbated in..

pregnancy! one cause of gestational diabetes

(MODY) maturity onset diabetes of the young

29

MODY

maturity onset diabetes of the young.

exacerbated by pregnancy

inactivating mutation in glucokinase.

poor glucose sensor in pancreatic beta cells, poor insulin release --> diabetes!

30

all cutaneous lymph from umbillicus to feet (including external genitalia & anus up to dentate line) drain to..

superficial inguinal nodes

(NOT testes, glans penis, and cutaneous portion of posterior calf)

31

branches of IMA

left colic, sigmoid, and superior rectal

32

how much vibrio does one need to ingest for infection?

a lot, 10^10 from water (bc acid sensitive)
recall: likes alkaline environment!

10^6 if from food bc buffering capacity.

if achlorydia, i.e. on omeprazole, need far less vibrio

33

ADH is made in..

supraoptic nucleus

34

oxytocin production is made in..

paraventricular

35

how are posterior pituitary hormones released into systemic circulation

BOTH hormones and neurphysins secreted into hypohysial vein to enter systemic circulation

(intravesicular protein used to transport hormones from hypothalamus into posterior pituitary)

36

anterior to pituitary? posterior?

anterior: optic chiasm
posterior: mamillary body

37

neurphysins

proteins involved in posttranslational processing of oxytocin and vasopressin.

released into circulation w/ posterior pituitary hormones (hypophyseal vein)

38

how does chloramphenicol work? major side effect?

binding to ribosomal 50S subunit, inhibits peptidyl-transferase

side effect: aplastic anemia

39

major side effect of clindamycin

pseudomembranous colitis (c. diff)

40

disulfram-like rxn post which drug?

metronidazole

41

AV fistula

abnormal communication between artery & vein, bypassing arteriole (major source of resistance in vascular system)

allows blood under ARTERIAL pressure --> venous system

presentation: pulsatile mass w/ thrill on palpitation. auscultation -> constant bruit.

42

AV shunt on pressure-volume loop in left ventricle

- increased preload (increased rate and volume of blood flow)

- reduced afterload (bypass arteriole)

43

true vs. false diverticula

true: all 3 layers: have mucosa, submucosa, muscularis, and serosa layers

false: mucosa & submucosa only. protrustion through wall

44

true or false diverticulum: Meckel's? Zenkers?

Meckels: true (also appendix)

Zenker's: false (also common colonic diverticula)

45

when does the vitillene (omphalomesenteric) duct normally obliterate

7th week of fetal life

46

rule of 2's w/ Meckel's diverticulum?

2% of population
2 feet from ileocecal valve
2 inches in length
2% asymptomatic
male 2x more affect
2 types of tissue possible: gastric / pancreatic

47

false / pulsion diverticulum are missing..

muscularis

only has mucosa and submucosa

usu herniation through muscularis layer

48

dysmenorrhea, dyspareunia, dyschezia with normal sized uterus? large uterus?

regular sized uterus: endometriosis

enlarged uterus: consider adenomyosis

49

adenomyosis

extension of endometrial tissue into uterine myometrium

dysmenorrhia, menorrhagia.

uniformed ENLARGED, SOFT globular uterus

tx: hysterectomy

50

physical exam of endometriosis?

ectopic collections of blood. blood undergoes hemolysis --> inflammation --> adhesions & distortion of organs

physical exam:
1. nodularity of uterosacral ligaments
2. fixed retroversion of uterus

51

explain symptoms of endometriosis

dysmenorrhea: shedding of ectopic tissue causes pain

dyspareunia: due to retroversion of uterus & endometrial implants on uterosacral ligaments

dyschezia: painful defecation due to pelvic adhesions

difficulty conceiving: adhesions in ovaries & fallopian tubes

note: ectopic endometrial tissue also interferes w/ ovulation & tubal function.

52

uterine malposition

retroversion is most common type. usu asymptomatic.

53

presentation of adenomyosis

dysmenorrhea (painful menses), abnormal bleeding, w/ LARGER uterus

54

major side effect of SSRI

sexual dysfunction

55

urinary retention is a side effect of drugs w/

antimuscarinic effects (i.e. TCA)

56

how to TCA's lead to orthostatic hypotension

anti alpha adrenergic effects

57

TCA side effects

1. antimuscarinic: urinary retention
2. anti alpha adrenergic: orthostatic hypotension
3. antihistamine: sedation
4. cardiac arrythmia
5. seizure (antihstamine, antimuscarinic, anesthetic)

58

what contains dihydrouracil, thymidine, acetylcytosine residues? significance?

tRNA

T arm: important for tRNA binding to ribosome.

59

3' end of tRNA

CCA

links to amino acids via aminoacetylation

60

D arm of tRNA

dihydrouracil residues

important for tRNA recognition by correct aminoacyl tRNA synthetases

61

what is the only RNA species that contains thymidine

tRNA

t arm

(thymidine, pseudouracil, acetylcysteine)

62

TATA box

binding of transcription factors: unwinding DNA and initiate separation of strands

63

what drug is contraindicated in individuals with low C1 esterase inhibitor?

ace inhibitors, worry about angioedema

64

hereditary angioedema

autosomal DOMINANT.

C1 esterase inhibitor deficiency

episodes of painless, non-putting, well-circumscribed edema

usu face, neck, lips and tongue.
internal organs may be involved.

angioedema of tracheobronchial tree can cause respiratory obstruction. potentially fatal.

angioedema of GI tract: abdominal pain, vomiting, and diarrhea

65

normal function of c1 esterase inhibitor (2). problem in c1 esterase inhibitor deficiency

1. block c1 complement activation
2. inhibits kallikrein

(prevents kallikrein from converting kininogen --> bradykinin)

in deficient state, kallikrein is high, leading to elevated bradykinin.

bradykinin + c3a + c5a --> angioedema

66

kallikrein 2 roles

1. convert plasminogen -> plasmin. which converts fibrin -> fibrin split products. which activates C1

2. convert kininogen -> bradykinin -> angioedema

67

why are ace inhibitors contraindicated in c1 esterase inhibitor deficiency?

c1 esterase inhibitor deficiency has elevated bradykinin

ACE inhibitors elevate bradykinin

both -> angioedema

68

toxicity of methotrexate (3)

hepatitis, pulmonary fibrosis, bone marrow suppression

69

most commonly dislocated joint in body?

glenohumeral joint, esp anterior.

shallow articulation between humeral head and glenoid fossa of scapula

70

anterior dislocation of humerus

results from forceful external rotation and abduction of arm at shoulder.

axillary n damage --> teres minor, deltoid, and cutaneous lateral aspect of arm

71

acromioclavicular joint subluxation

downward blow on tip of shoulder. produces swelling and upward displacement of clavicle. not associated w/ specific nerve injury

72

spiral humeral midshaft fracture

result from torsion produce from fall on outstretched hand

radial n damage

73

fracture of coracoid process

rare. usu people who engage in shotgun or rifle-related shorts

74

efficacy of oral contraceptives

MOSTLY bc estrogen blocks midcycle gonadotropin surge, inhibiting ovulation.

progesterone: 1. counteract increased risk of endometrial cancer w/ unopposed estrogen 2. also decreases permeability of cervical mucus to sperm 3. also inhibits endometrial proliferation needed for implantation

75

serious risk w/ oral contraception

deep vein thrombosis, PE, ischemic stroke, MI

increased in SMOKERS over the age of 35. ESPECIALLY smoking status.

76

absolute contraindications to use of OCP (6)

1. prior history of thromboemolic event/stroke
2. history of estrogen-dependent tunmor
3. over 35 y/o & smoke heavily
4. hypertriglyceridemia
5. decompensated or active liver disease (impair steroid metabolism)
6. pregnancy

77

4 signs of lead poisioning

LEAD Sucks\

lead lines, encephalopathy & erythrocyte stippling, abdominal colic and sideroblastic anemia, drops: foot and wrist, rx: dimercaprol and edta. succimer for kids

1. colicky abdominal pain, constipation, headaches, impaired concentration, defecits in short-term memory.

2. bluish pigmentation at gum-tooth line & metaphyses of long bones (bruton lines)

3. wrist drop or foot drop due to peripheral neuropathy

4. microcytic hypochromic anemia & basophilic stippling on peripheral smear.

78

ways to be exposed to lead

manufacture of batteries, alloys, ammunition.

mining, smelting, chemical processing, recycling, spray painting, radiator repair

79

4 stages of iron poisioning

1. nausea, diarrhea, abdominal pain. w/ hemorrhage, hypovolemia, and shock in severe cases.

2. GI symptoms resolve, patient seems better

3. metabolic acidosis, hepatic dysfunction, hypoglycemia

4. scarring o the recovering GI tract

80

toxic metabolite of methanol

formaldehyde, formic acid

81

toxic metabolite of ethylene glycol

oxalic acid

82

cause of on-off phenomenon of L-dopa/carbidopa

unpredictable, dose-independent

83

describe on-off phenomenon of L-dopa/carbidopa

dyskinesia after dose, akinesia between doses

sudden loss of anti-parkinsonian effects of L-dopa --> hypokinesia and rigidity.

usu after long-term administration

84

wearing off phenomenon of L-dopa/carbidopa

progressive destruction of striatonigral dopaminergic neurons over a period of time.

dose dependent & predictable (vs. on off phenomenon)

85

histology of both lymphatics and glomerular capillaries

SINGLE layer of endothelial cells. junction between --> allow passage of molecules, fluid, and electrolytes.

[podocytes also there in glomerulus]

86

rx for borrelia burgdorferi (2)

doxycylcine or ceftriaxone (penicillin-type antibiotics)

87

phases of lyme disease

(1) early localized: days to weeks post exposure: flu like symptoms, characterestic erythema migrans

(2) early disseminated: CNS or cardiac (bell's palsy, AV block)

(3) chronic: months to years, if not given antibiotics, asymmetric arthritis (usu involving single knee joint) and/or subacute encephalopathy (decreased memory, somnolence, mood change)

88

excessive dopamin blockade in striatum leads to excessive..

excitatory cholinergic M1 activity

rx: acute dystonia etc: benztropine adnd diphenhydramine

89

antipsychotic w/ highest H1 blockade

chlorpromazine and clozapine

90

low potency antipsychotics. greater risk of..

chlorpromazine, thioridazine
lower potency at D2 receptors.

-- nonneurologic side effects: anticholinergic, antihistamine, anti-alpha1 adrenergic

91

high potency antipsychotics. greater risk of

trifluoperazine, fluphenazine, haloperidol

higher potency at D2 receptors

more EPS symptoms

92

testing for t. pallidium

first: RPR/VDRL
mixes pt serum w/ cardiolipin, cholesterol and lecithin.

[these are human cellular lipids released into blood stream after cell destruction by t. pallidum

nonspecific: positive in all subspecies of t. pallidum (yaws, pintal, bejel..)

also VDRL: common false positives
Viruses (EBV, hepatitis), drugs, rheumatic fever, lupus

second: specific.
FTA-ABs
indirect immunofluorescence of patients serum mixed w/ whole killed T. pallidum.

93

common false positives w/ VDRL?

virus (EBV, hepatitis)
drugs
rheumatic fever
lupus

94

rheumatoid factor

anti-Fc IgM.

positive in most cases of rheumatoid arthritis,

presence does not definitively established.
absence does not definitively exclude.

95

cold agglutins test for..

mycoplasma infection

blood added to a tube w/ EDTA, placed in ice --> agglutinate

96

most common cause of death in patient hospitalized for MI

ventricular failure (cardiogenic shock)

97

what might be protective against ventricular free wall rupture 3-7 days post MI?

LV hypertrophy and prior MI

98

crystals in pseudogout? aspirate shows? joint involved

rhomboid weakly + birefringent (blue) in polarized light & neutrophils

calcium pyrophosphate

often large joint (knee)

99

parinaud syndrome (dorsal midbrain synrdrome)

paralysis of upward gaze

consistent w/ tumor in pineal region

100

most common tumor of pineal gland

GERMINOMA; originate from embryonic germ cells.

usu kids, strong male preponderance.

secrete b-hCG --> precocious puberty

101

presentation of pineal germinoma

(1) precocious puberty in male, due to b-hCG

(2) obstructive hydrocephalus (aqueductal stenosis)

(3) parinaud syndrome: paralysis of upward gaze and convergence, compression of tectal (superior colliculus)

102

presentation of locked-in syndrome

spastic quadriplegia (loss of upper motor neurons in pons)

paralysis of most cranial nerves (damage to nuclei)

103

basic lateral medullary syndrome

contralateral loss of pain & temperature

ipsilateral paralysis of CN V, IX, X, XI

dysphagia and hoarseness
don't PICA hoarse that can't eat

104

basic medial medullary syndrome

contralateral spastic paralysis

ipsilateral flaccid paralysis of tongue

105

most common location for brain germinomas

pineal gland (histologically similar to testicular seminomas)

106

lateral pontine syndrome

AICA lesion

facial droop means AICA is pooped

107

test for prinzmetal angina

ergonovine.

most sensitive provative diagnostic test for coronary vasospasm.

ergot alkaloid, constricts vascular smooth muscle by stimulating both alpha-adrenergic and 5-HT receptors.

induces coronary spasm, chest pain, and ST-segment elevation

108

rx for prinzmetal angina

amlodipine
calcium channel blocker

109

3 morphologic variants of pneumonia

bronchopneumonia
- patchy inflammation of a number of lobules

interstitial pneumonia
- inflammatory infiltrate in alveolar walls

lobar pneumonia
- involves entire loung lobe

110

4 stages of lobar pneumonia

congestion (24 hr)
- red heavy boggy
- vascular dilation
- alveolar BACTERIAL exudate

red hepatization (day 2-3)
- red, firm lobe (liver-like)
- alveolar exudate: erythrocytes, neutrophils, fibrin

gray hepatization (day 4-6)
- gray-brown, firm lobe
- RBC disintegrate
- alveolar exudate contains neutrophils and fibrin

resolution
- restoration of normal architecture
- enzymatic digestion of exudate

[fibrinous exudates may not resorb completely --> REORGANIZATION: may lead to development of pleural adhesions

111

acute pyelo normally caused by

e. coli
klebsiella
proteus
enerococci

112

defense mechanism of bladder

1. bladder mucosa normally does not allow bacterial attachment

2. normal urine is bactericidal (high urea, high osmolarity

3. urine flow washes bacteria downstream

cystitis: disruption of these mechanisms or overcome by bacterial virulence factors

113

pathogenesis of lower UTI (3)
development of acute pyelo?

lower UTI:
1. supression of endogenous flora
2. colonization of distal urethra by pathogenic gram negative rods
3. attachment to bladder mucosa

pyelo: anatomic / functional vesicuuretral reflux! (hematogenous spread less common)

114

cystitis, and urine has ammonia scent -->

suggests proteus mirabilis infxn

115

thyroidization of the kidney suggests

chronic pyelonephritis

tubules w/ eosinophilic casts.

116

location of gastrinomas

neuroendocrine tumor
pancreas
peripancreatic tissue around head
duodenum.
results in gastrointestinal ulcers in unusual locations (i.e. postbulbal duodenum and jejuneum

117

newly diagnosed gastrinoma must be worked up for..

serum calcium, PTH, and pituitary hormones

bc of association with MEN-1

118

necrolytic migratory erythema

raised erythematous rash, typically in groin area.

associated w/ pancreatic glucagonoma

119

measure of visceral fat to subcutaneous fat?

waist-to-hip ratio
waist: viscera
hip: subcutaneous fat

high ratio, associated w/ insulin resistance

120

presentation of bronchioloalveolar carcinoma

uncommon, 10% of all

pneumonia-like consolidation. can expectorate pale tan fluid

121

rheumatoid lung disease

pulmonary fibrosis

122

auscultation of pulmonary fibrosis

end inspiratory rales at lung bases

123

etiology of pulmonary HTN in patient secondatry to left-sided heart failure

reactive vasoconstriction due to venous congestion

increase pulmonary venous congestion --> capillary leak (increased hydrostatic pressure) --> pulmonary edema.

edema causes alveolar collapse & decreased ventilation --> hypoxemia.

reactive vasoconstriction occurs in order to shunt blood to areas w/ better ventilation.

124

most common cause of left ventricular diastolic dysfunction?

chronic HTN.

concentric LV hypertrophy, decreases LV diastolic compliance.

as a result: steady state LV filling pressures rise to maintain SV & CO --> LA pressure elevation --> pulmonary venous congestion

125

etiology of pulmonary HTN secondary to COPD

respiratory hypoxia-induced vasoconstriction

leads to polycythemia and obliteration of vasculature --> compounding increased pulmonary aterial pressure.

126

increased flow volume and pressure in pulmonary vasculature results secondary to..

left-to-right shunt

large VSD or ASF

--> pulmonary HTN

127

pyruvate kinase

converts PEP to pyruvate

phosphoenolpyruvate --> pyruvate\

allosterically stimulated by F1,6BP (made from F6P from PFK), says: glycolysis is happening

128

pyruvate kinase deficicency

can't get maximal ATP from glycolysis (no TCA)

defective maintenance of RBC architecture bc low ATP.

splenomegaly -- work hypertrophy

129

work hypertrophy of spleen

hypertrophy of reticuloendothelial cells of splenic parenchyma (involved in removal of damaged RBC)

130

skeletal abnormalities of marfans

long extremities
long tapering fingers
spinal scoliosis and/or kyphosis

131

1st cause of death in Marfan's. 2nd?

1: aortic dissection
2. cardiac failure (secondary to mitral and/or aortic regurg from prolapse or dilation of aorta)

132

receptor changes w/ long-tern ethanol use (3)

1. downregulation of GABA
- normally binds & potentiates effects

2. upregulation of NMDA receptor
-normally inhibits NMDA

3. increase synthesis of excitatory mediaors: NE, 5-HT, dopamine

leads to tolerance (need to increase dose to get desirable effect) and withdrawal upon cessation. --> substance dependence

133

timing of alcohol withdrawal.

starts 5-10 hours after last drink
intensifies in 2-3 days
subside by 4-5

134

most common manifestation of alcohol withdrawal?

the shakes -- tremulousness

also:
-autonomic dysfunction (increased HR, respiration, body temp)
-GI distress (nausea, vomiting)
-insomnia, agitation, anxiety

135

tonic clonic seizure in alcohol withdrawal

in <5% of people.
occur within 48 hours

136

delirium tremens

fluctuant arousal levels, potentially FATAL.

begin 48-72 hours after last drink.

also: severe sympathetic hyperactivity (BP, body temp, perspiration), hallucinations: like FORMICATION, and confusion

137

alcoholic hallucinations

affect <25% of alcoholics in withdrawal

138

carcinoid tumors arise from

enterochromaffin (endocrine) cells of intestinal mucosa

139

to be symptomatic from carcinoid tumor..

it must have metastazied to liver OR be extraintestinal

if GI only, will be metabolized to inactive pieces.

140

symptoms of metastasized /extraintestinal carcinoid tumor

1. vasomotor instability: cutaneous flushing, instability
2. GI symptoms: secretory diarrhea, crampy abdominal pain
3. bronchoconstriction
4. right sided valvular heart disease

141

why are there no left sided heart issues w/ metastatic / extraintestinal carcinoid tumor?

lung has MAO -- degraded vasoactive substances.

142

biliary atresia

complete obstruction of extrahepatic bile ducts

presents 3-4th week of life

dark urine, acholic stool, conjugated hyperbillirubinemia

liver biopsy:
1. intrahepatic ductular proliferation
2. portal tract edema
3. parenchymal cholestasis

143

D-isoimmunization

hemolytic disease of newborn
Rh+ infant w/ Rh- mothers.

jaundice within 24 hrs of birth.

lab: unconjugated hyperbilirubinemia, hemolytic anemia, positive Coombs test

144

jaundice within 24 hrs of birth

hemolytic disease of newborn, D-isoimmunication (Rh+ infant w/ Rh- mama)

145

jaundice in 3-4th week of life

biliary atresia

146

jaundice AFTER 1st day of life, SUBSIDES 1 week later

physiologic jaundice

147

jaundice w/ stress (fasting, illness)

gilbert syndrome

reduced UDP-glucoronyl transferase

148

physiologic jaundice

after 1st day of life.
subsides after 1st week.

relatively mild unconjugated hyperbillirubinemia

149

cystic duct obstruction often leads to.. describe. complications

acute cholecystitis.

obstruction. fatty meal --> CCK --> contraction against obstruction --> tissue becomes inflamed (as a result of prostaglandin release and stony disruption to mucosal layer)

--> ischemic changes in edematous & distended organ --> followed by bacterial invasion

complications: gangrene and perforation w/ generalized peritonitis or well-circumscribed abscess

150

what does failed gallbladder visualization on HIDA (radionucleotide billary scan) suggest?

cannot visualize gallbladder: CYSTIC DUCT.
goes from liver --> bowel

suggests stone obstructing cystic duct.

bile cannot go from liver -> hepatic duct -> cystic duct

instead liver -> hepatic duct -> bile duct -> bowel

151

what does filling of gallbladder on HIDA but poor ejection suggest?

obstruction in common bile duct

(cystic duct clear, bc liver bile -> hepatic duct -> cystic duct fine)

152

gallstone visualization

ULTRASOUND

not enough calcium for X-ray

153

definitive diagnosis of acute cholecystitis

HIDA SCAN!
-lack of filling (cystic duct obst)
-lack of ejection (common duct obst)

just STONES on ultrasound is NOT sufficient (many have and are asymptomatic)
need: distended gallbladder, wall thickening, pericholescystic fluid, positive sonographic murphy