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GIR Test 3 > B5-022 CBCL: Cholecystitis-lithiasis > Flashcards

B5-022 CBCL: Cholecystitis-lithiasis Flashcards

1
Q

drugs that increase risk of cholelithiasis

2

A
  • octreotide
  • clofibrate
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2
Q

calcium bilirubinate polymer formed in gallbladder

A

black pigment stone

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3
Q

mixture of cholesterol/fatty soap/calciu bilirubinate formed in bile duct

A

brown pigment stone

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4
Q

[…] pigment stones are associated with chronic hemolysis and Crohn’s

A

black

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5
Q

deconjugates bilirubin causing insoluble calcium bilirubin salts

A

bacterial B-glucoronidase

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6
Q

> 80% of all gallstone cases are caused by

A

cholesterol stones
(cholesterol monohydrate crystal)

20% pigment stones

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7
Q

conditions favor gallstone formation

A

lithogenic stage

first stage

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8
Q

episodes of biliary colic after a fatty meal

A

symptomatic gallstones

third stage

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9
Q
  • usually asymptomatic
  • may be discovered on imaging performed for reasons other than gallbladder disease
A

cholelithiasis

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10
Q
  • RUQ pain/tenderness
  • fever
  • positive murphy’s sign
A

acute cholecystitis

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11
Q

what laboratory findings would you expect in acute cholecystitis?

A
  • increased WBC
  • mildy elevated bili
  • mildly elevated transaminase
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12
Q

best initial step for diagnosis of acute cholecystitis

A

RUQ ultrasound

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13
Q

what should you see on ultrasound for diagnosis of acute cholecystitis?

A
  • gallstones
  • anterior wall >3mm thick
  • pericholecystic fluid
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14
Q

treatment of acute cholecystitis

A
  • IV fluids
  • antibiotics
  • patient NPO
  • monitor for 48 hours

if symptoms worsen, urgent cholecystectomy. if not, schedule in 6 weeks

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15
Q
  • fever
  • RUQ pain/tenderness
  • positive murphy’s sign
  • scleral icterus/jaundice
A

choledocholithiasis

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16
Q

what would you expect to see on US of choledocholithiasis?

A
  • gallstones
  • common bile duct >8 cm dilated
  • obstruction of biliary tract at the level of common bile duct
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17
Q

treatment for choledocholithiasis

A

ERCP spinchterotomy and retrieval of stone

elective cholecystectomy may follow

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18
Q
  • fever
  • RUQ pain/tenderness
  • positive Murphy’s sign
  • scleral icterus/jaundice
  • AMS
  • hypotension
  • sepsis
  • Reynold’s pentad
A

acute ascending cholangitis

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19
Q

Reynold’s pentad

A
  • fever
  • RUQ pain
  • jaundice
  • AMS
  • hypotension

acute ascending cholangitis

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20
Q

treatment of acute ascending cholangitis

A
  • IV fluids, hemodynamic stabilization
  • antibiotics
  • urgent biliary drainage
  • ERCP

elective cholecystectomy may follow

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21
Q

expected lab findings for choledocholithiasis?

A

elevated WBCs
mildy elevated bili/transaminases

same for cholecystitis

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22
Q

expected lab findings for acute ascending cholangitis?

A
  • elevated WBCs
  • mildly elevated bili/transaminases
  • elevated alk phos
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23
Q

charcot triad

A

jaundice
fever
RUQ pain

cholangitis

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24
Q

infection of the biliary tree usually due to obstruction that leads to stasis/bacterial overgrowth

A

ascending cholangitis

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25
Q

presence of gallstone in common bile duct

A

choledocholithiasis

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26
Q

risk factors for cholelithiasis

A
  • female
  • fat (obesity)
  • fertile (mulitparity)
  • forty
  • fair

5 Fs - First Aid

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27
Q

causes of cholelithasis

A
  • elevated cholesterol/bilirubin
  • decreased bile salts
  • gallbladder stasis
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28
Q

which type of stones are radiolucent?

2

A

cholesterol stones
brown pigment

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29
Q

which type of stones are radiopaque?

A

black pigment stones

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30
Q

carries nutrient rich blood into the liver

A

portal vein

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31
Q

provides oxygenated blood to liver

A

hepatic artery

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32
Q

collect blood from liver and take it to IVC

A

hepatic veins

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33
Q

bile duct epithelial cells

A

cholangiocytes

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34
Q

liver resident macrophages

A

Kupffer cells

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35
Q

major storage site for vitamin A

A

stellate cells

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36
Q

form a heterodimer to transport cholesterol into the bile

A

ABCG5/ABCG8

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37
Q

major transporter for secretion of bile acids from hepatocytes into bile

A

BSEP

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38
Q

lipid translocator that moves phosphatidylcholine from the inner leaflet to outer leaflet of the canalicular membrane for extraction into the lumen by bile salts

A

MDR3

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39
Q

exports bilirubin from hepatocytes into bile

A

MRP2

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40
Q

mediates intestinal cholesterol absorption

A

NPC1L1

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41
Q

mediates hepatocytes apical cholesterol secretion into bile

A

ABCDG5

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42
Q

how do bile salts and phospholipids prevent cholesterol precipitation in the bile?

A

forming mixed micelles

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43
Q

stimulates gallbladder contraction after a meal

A

CCK

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44
Q
  • produced in the ileum in response to bile acid absorption
  • regulates bile acid synthesis
A

FGF19

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45
Q

[…] pigment stones are formed in the gallbladder due to hypersecretion of bilirubin

A

black

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46
Q

chronic hemolytic anemia is associated with […] pigment stones

A

black

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47
Q

usually formed in the biliary tract and associated with chronic biliary tract infection

A

brown pigment stone

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48
Q

deconjugates bilirubin and contributes to brown stone formation in the biliary tract

A

bacterial B-glucoronidase

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49
Q

acute cholecystitis is most often to result of gallstone blockage of the

A

cystic duct

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50
Q

blockages of the ampulla of Vater leads to

A

jaundice

51
Q

pro-nucleating agent in supersaturated bile

A

mucin

52
Q

high molecular weight glycoprotein secreted by the gallbladder with the ability to bind lipids and bile pigment

A

mucin

53
Q

anti-nucleating agent

A

apolipoprotein AII

54
Q

bile stasis and decreased function of the spinchter of Oddi cause bacteria to migrate into the biliary tract causing

A

acute ascending cholangitis

55
Q

ascending cholangitis caused by choledocholithiasis is often a result of

A

bacteria entering the biliary tree through the ampulla of Vater

56
Q

which serum markers indicate biliary tract injury?

A

ALP
GGT

57
Q

major basolateral conjugated bile acid uptake transporter

A

NTCP

58
Q

mutation of […] results in decreased hepatic uptake of bile acids from the portal blood

A

NTCP

59
Q

mutation of […] results in impaired canilicular bile acid secretion into the bile results in intrahepatic bile acid accumulation

A

BSEP

60
Q
  • canalicular phospholipid transporter
  • mutation associated with intrahepatic cholestasis PFIC-3
A

ABCB4 (MDR3)

61
Q

mutation of […] is associated with PFIC-1

A

ATP8B1

62
Q

mutation of […] is associated with hypercholesterolemia and premature atherosclerosis due to reduced cholesterol conversion to bile acids

A

CYP7A1

63
Q

best initial method for evaluating gallbladder pathology

A

US

64
Q

characteristic features of ascending cholangitis

A

fever
jaundice
RUQ pain

65
Q

result of bacterial infection-mediated release of beta-glucuronidase

A

brown pigment stones

66
Q

increased unconjugated bilirubin precipitates as […], resulting in brown pigment stones

A

calcium salts

67
Q

range in color from yellow to dark green and are due to the supersaturation of bile with cholesterol

A

cholesterol stones

68
Q

[…] stones are associated with infected bile and can often be found outside the gallbladder in the intrahepatic or extrahepatic ducts

A

brown stones

69
Q
  • biliary colic
  • hx of cholecystectomy
  • common bile duct dilation
A

spinchter of Oddi dysfunction

70
Q

treatment for spinchter of Oddi dysfunction

A

sphincterotomy via ERCP

71
Q

best diagnotic modality for spinchter of Oddi malfunction

A

manometry via ERCP

measures pressures

72
Q

often confused with cholelithiasis until the patient’s symptoms persist post cholecystectomy

A

spinchter of Oddi malfunction

73
Q

thin layer of mineralization outling the gallbladder wall on US

A

porcelain gallbladder

74
Q

calcified gallbladder due to chronic cholecystitis

A

porcelain gallbladder

often asymptomatic and found on incidental imaging

75
Q

most common cause of porcelain gallbladder

A

recurrent biliary colic

76
Q

gallbladder wall thickening on US is characteristic of

A

cholecystitis

77
Q

distended gallbladder with clear fluid accumulation as a result of long standing cystic duct blockage

A

hydrops of gallbladder

78
Q

gallbladder distention and stones pressing the gallbladder wall cause ischemia and necrosis

A

gangrenous cholecystitis

79
Q

gallbladder calcification increases the risk for

A

gallbladder carcinoma

80
Q

do asymptomatic patients generally require cholecystectomy?

A

no

exception: porcelain gallbladder and Native Americans

81
Q

patients at risk for gallbladder cancer should have a cholecystectomy. what populations would this include?

A
  • porcelain gallbladder
  • Native Americans
82
Q

the presence of […] suggests the patient has a high risk for developing ascending cholangitis

A

jaundice

83
Q

the presence of […] in the stool gives it its brown color

A

bilirubin

84
Q

choledocholithiasis, biliary atresia, and hepatitis can decrease […], causing stool to appear pale in color

A

bilirubin release into intestine

85
Q

conjugated bilirubin is exported across the […] of the hepatocytes into systemic circulation

A

basolateral side

86
Q

[…] causes black stones in the gallbladder

A

hemolytic anemia

87
Q

risk factors for cholesterol stones

A
  • female
  • fat
  • fertile
  • fair
  • fourty
88
Q

which type of pigment stone is more frequently formed in bile ducts?

A

brown

89
Q

composed of calcium salts of unconjugated bilirubin and cholesterol

A

brown pigment stones

90
Q

which type of stone is associated with chronic bacterial or parasitic infection of the bile duct?

A

brown pigment

91
Q

what happens to unconjugated bilirubin in the presence of calcium?

A

forms highly insoluble calcium salts and complexes with other liquids to form pigmented stones

92
Q

formed in the gallbladder and consist of crosslinked unconjugated bilirubin polymer and calcium salts

A

black pigment

93
Q

bile acid sequestrants

2

A
  • cholestipol
  • cholestyramine
94
Q

2 drug classes used to treat hypercholesterolemia

A
  • bile acid sequestrants
  • statins
95
Q

2 drug classes used to treat hypertriglyceridemia

A

PPARa agonists fibrates (gemfibrozil)
niacin

96
Q

activates PPARa to increase biliary cholesterol secretion and decrease bile acid synthesis

A

gemfibrozil

contributes to cholesterol supersaturation in bile

97
Q

thought to decrease lipids by inhibiting adipose lipid release

A

niacin

98
Q

how does rapid weight loss contribute to the development of gallstones?

A
  • causes adipose to release a large amount of cholesterol via lipolysis
  • causes increased hepatic cholesterol uptake and biliary cholesterol hypersecretion

causes cholesterol superaturation in bile

99
Q

do incidentally detected gallstone in patients without symptoms need treatment?

A

no

100
Q

describe appropriate management of acute cholecystitis

A
  • IV antibiotics and observe
  • if improvement in 48 hrs -> schedule elective cholecsytectomy within 6 weeks
  • if no improvement/worsening–> urgent cholecystectomy
101
Q

contraindicated in pregnancy due to potential risk of miscarriage and effects on fetus

A

NSAIDs

102
Q

what can be used in pregnant women for pain management?

A

acetaminophen
opioids

103
Q

what does the Reynold’s pentad indicate?

A

ascending cholangitis progressing to septic shock

104
Q

what lab findings indicate acute pancreatitis?

A

serum lipase 3x upper limit of normal
glucose of 190 ml/dl

105
Q
  • itching
  • dark-colored urine
  • light colored stool

indicates a problem with

A

indicates a problem with bile excretion

106
Q

how do issues with bile excretion cause dark colored urine?

A

when bile cant be excreted by the intestine, it is excreted by kidneys

107
Q

first line treatment for PBC

A

ursodiol

UCDA

108
Q

promotes biliary secretion, decreases inflammation and cell death, reduces the hydrophobicity of bile acid pool

medication

A

ursodiol

109
Q

characterized by pruritis, elevated serum bile acids and developing 2nd/3rd trimester

A

ICP

resolves quickly after delivery

110
Q

treatment for ICP

A

ursodiol

UDCA

111
Q

what is the cause of gallstone in Crohn’s disease?

A
  • decreased bile acid reabsorption
  • lower bile acids in bile
  • increased bilirubin -> cholesterol supersaturation
112
Q

acute necroinflammatory disease of the gallbladder without evidence of gallstones or duct obstruction

A

acalculous cholecystitis

113
Q

due to gallstone impaction of the cystic duct resulting in inflammation and gallbladder wall thickening

A

calculous cholecystitis

114
Q
  • due to gallbladder stasis, hypoperfusion, or infection
  • seen in critically ill patients
A

acalculous cholecystitis

115
Q

results from gallbladder stasis and ischemia, which then cause a local inflammatory response in the gallbladder wall

A

acalculous cholecystitis

116
Q

treatment of acalculous cholecystitis

A
  • IV fluids
  • pain control
  • antibiotics
  • cholecystectomy
117
Q
  • critically ill patients with sepsis without a clear source or jaundice
  • fever, abdominal pain
A

acalculous cholecystitis

118
Q

ischemia, sepsis, gallbladder stasis cause

A

acalculous cholecystitis

119
Q
  • direct hyperbilirubinemia
  • scleral icterus for years
  • hyperpigmentation of liver
A

Dubin Johnson

120
Q
  • indirect hyperbilirubinemia
  • can remain asymptomatic until adulthood
A

Crigler-Najjar type II

121
Q

most common inherited hyperbilirubinemia

A

Gilberts

122
Q

presents with indirect hyperbilirubinemia in times of stress

A

Gilbert

123
Q

jaundice and unconjugated hyperbilirubinemia between the 3rd and 8th day of life

A

physiologic neonatal jaundice

124
Q

what causes physiologic neonatal jaundice?

A
  • increased fetal RBC turnover
  • immature newborn liver (decreased UDP)

GIR Test 3 (16 decks)

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