17 - Biliary Dz Flashcards
where is alk phos found in GI tract?
cells lining bile ducts
how is bili measured?
measured as it is cleaved into measurable component
conjugated bili is cleaved quickly, unconjugated requires accelerant
therefore, measure conjugated, then add accelerant to measure total
at what bili level do you get jaundiced?
> 3 mg/dl
what can cause decreased bilirubin uptake by liver?
meds like rifampin
inherited disorders of bilirubin conjugation
Crigler-Najjar type 1 and 2 - absent or markedly reduced conjugation (respectively) beginning in infancy - early childhood. elevated unconjugated bilirubin. Tx type 1 w/ phototherapy and type 2 w/ phenobarbital
Gilbert’s - mild reduction of conjugation, presents in adolescence. mildly elevated serum bili.
stigmata of chronic liver disease (7)
spider nevi palmar erythema gynecomastia caput medusa splenomegaly asterixis ascites
which bleeding test is relevant to liver dz?
PT - measures vit K dependent factors better
MC type of gallstone
cholesterol
black vs brown pigmented stones assoc w/
black - excess unconjugated bili outside bile duct - hemolysis, cirrhosis, ileal dz
brown - chronic biliary infxn
complications of choledocholithiasis
colic, jaundice, cholangitis, pancreatitis
things that put pt at high risk for bile duct obstruction problems
cholangitis
dilated CBD >6 cm
CBD stone on US
bili > 4
tx of choledocholithiasis
endoscopic retrograde cholangiopancreatography
or laparoscopic surg
Charcot’s triad
fever, RUQ pain, jaundice
indicates high chance of acute cholangitis
how often are acute cholangitis pts bacteremic?
50%
acute cholangitis tx
abx + biliary drainage (more severe > drain more urgently)
