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Clin med A 2 > Trigger - Gallbladder > Flashcards

Trigger - Gallbladder Flashcards

1
Q

normal exam and labs. RUQ pain radiating to back

A

cholelithiasis

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2
Q

treated with NSAIDS or lap chole

A

cholelithiasis

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3
Q

what is the difference when treating a native american patient w cholelithiasis

A

lap chole instead of NSAIDS just becauase they are more prone to stones

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4
Q

what can be used in lap chole’s to avoid injury to the common bile duct

A

intraoperative cholangiogram

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5
Q

treat with ursodeoxycholic acid

A
  • non surgical candidates with symptomatic cholelithiases
  • Primary sclerosing cholangitis patients (in addition to cipro, ERCP, stenting, transplant, ect.)
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6
Q

MC in Men 20-50

A

primary sclerosing cholangitis

also MC in IBD (UC or CD)

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7
Q

MC in pts with UC or CD

A

Primary sclerosing cholangitis

also MC in men 20-50

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8
Q

MC in critically ill pts or post op pts after major surgery

A

acute acalculous cholecystitis

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9
Q

RUQ pain with fever, tachycardia and NV

A

cholecystitis

also see:
+ murphys sign
luekocytosis
normal LFT

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10
Q

+ murphys sign
leukocytosis
normal LFTs

A

acute cholecystitis

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11
Q

US showing stone lodged at cystic duct and gallbladder thickening > 4mm

A

acute cholecystitis

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12
Q

HIDA scan shows obstructed cystic duct and nonvisualized gallbladder. also shows GB EF of 12%

A

acute cholecystitis

remembe EF<35% = lap chole needed

primary imaging is US tho

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13
Q

who is HIDA CI in

A

pregggooooooooo

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14
Q

what is the name for a stone in the neck of the gallbladder causing jaundice post acute cholecystitis

A

mirizzi syndrome

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15
Q

what is the term for when acute cholecystitis subsides but the cystic duct is still blocked

A

Hydrops of gallbladder

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16
Q

what is the tx for acute cholecystitis

A

Pip/taz
OR
Mid gen ceph + metro
OR
Cipro + metro

also NPO and NG tube
also IV meperidine or NSAIDS
also lap chole in 1-2 days

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17
Q

In a high risk patient (elderly or DM) what tx is used instead of lap chole

A

percutaneous cholecystectomy

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18
Q

RUQ pain, jaundice, NV, epigastric tenderness

A

choledocholithiasis

19
Q

high AST/ALT
hyperbilirubinemia

later on high ALP and GGT

A

choledocholithiasis

20
Q

RUQ pain with elevated LFTs

A

choledocholithiasis

21
Q

Transabdominal U/S showing CBD dilation

A

choledolithiasis

22
Q

ERCP with sphincterotomy and stent + cholecystectomy

A

choledocholithiasis treatment

23
Q

confirmation of diagnosis with MRCP or endoscopic US

A

choledolithiasis

24
Q

what must be present for ERCP

25
RUQ pain, Fever, Jaundice, Hypotension, AMS
acute cholangitis
26
leukocytosis, elevated CRP, bilirubin and PTT
cholangitis also may see elevated AST/ALT and ALP
27
diagnostic criteria for acute cholangitis
1. systemic inflammation (fever or high CRP) 2. bilirubin of >2 or LFTs>1.5 UNL 3. imaging showing dilation or presence of stone/stricture/stent
28
treatment for acute cholangitis
Admit ASAP ERCP within 48 hours Lap Chole after ERCP Mild-mod: Cipro + metro Severe (organ damage): Zosyn + Metro
29
immune response to endotoxins
primary sclerosing cholangitis
30
presents with 6 phases. name the six phases and the disease
primary sclerosing cholangitis Asymptomatic Obstructive jaundice Progressive jaundice Pruritis Fatigue, anorexia, indigestion Hepatosplenomegaly
31
elevated AST/ALT, ALP and hypergammaglobulinemia. also elevated IgM and P-ANCA
prijmary sclerosing cholangitis
32
MRCP shows beads on a string
primary sclerosing cholangitis (imaging of choice)
33
liver biopsy showing onion skin
primary sclerosing cholangitis (last resort imaging)
34
Cipro for acute episodes Ursodeoxycholic acid under testing Symptomatic treatment only and management only
primary sclerosing cholangitis
35
Incurable disease with prognosis of 9-17 yrs :(
primary sclerosing cholangitis
36
Chronic infection with salmonella typhi
gallbladder carcinoma also presents with polyps and calcification
37
MC in ages 50-70
cholangiocarcinoma
38
Confluence of the hepatic ducts is MC spot
cholangiocarcinoma
39
more common in primary sclerosing cholangitis and biliary cirrhosis
cholangiocarcinoma also Immunocomp
40
Distended, palpable gallbladder is called what? when is this seen
courvoisier sign seen in carcinomas of biliary tract`
41
RUQ tenderness, Hepatomegaly, Courvoisier sign, Ascites
carcinoma of biliary tract
42
CA 19-9 on labs
carcinoma of biliary tract also elevated LFTs and hyperbilirubinemia
43
tx is Roux-en-y-hepaticojejunostomy
non-resectable carcinoma of biliary tract

Clin med A 2 (30 decks)

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