biliary Flashcards

1
Q

what is cholestasis

A

blocked bile flow

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2
Q

what is cholelithiasis

A

gallstones

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3
Q

cholangitis

A

inflamm of bile ducts

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4
Q

cholecystitis

A

inflamm of gallbladder

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5
Q

what is biliary colic

A

RUQ from gallstones in bile ducts

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6
Q

what 3 ducts form the common bile duct

A

right and left hepatic duct (from liver) + cystic duct (from gallbladder)

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7
Q

what forms the apulla of vater

A

common bile duct and pancreatic duct

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8
Q

what controls flow of bile and pancreatic secretions into duodenum

A

sphincter of Oddi

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9
Q

who commonly gets gallstones

A

fat fair female 40

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10
Q

what conditions are RF for gallstones

A

Crohns // DM // rapid weight loss

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11
Q

biliary colic presentation

A

colicky RUQ pain postprandially + worse fatty meal //no fever and normal LFTs + normal inflamm

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12
Q

when do gallstones cause symptoms (anatomically)

A

in CBD // in gallbladder alone they are common and do not require treatment

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13
Q

invx of gallstones complications

A

abso USS and abnormal LFT’s (usually ALT) –> MCRP (if in CBD)

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14
Q

how are gallstones managed

A

(ECRP if gallstones in CBD not causing complications) —> lap chole (gold standard)

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15
Q

RF of ECRP (4)

A

bleeding // duodenal perforation // cholangitis // pancreatitis

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16
Q

common complications of gallstones

A

acute cholecystitis // acute cholangitis // obstructive jaundice // pancreatitis

17
Q

what is the most common cause of acute cholecystitis

A

gallstones (90%)

18
Q

features of acute cholecystitis

A

RUQ and right shoulder tip pain // systemically unwell // murphy’s sign (inspiratory arrest on RUQ) // normal LFT’s

19
Q

what would derranged LFT’s in acute cholecystitis indicate

A

Mirizzi syndrome –> compression of CBD (normally normal LFTs)

20
Q

1st and 2nd line invx acute cholecystitis

A

1st = USS // 2nd = HIDA scan

21
Q

mx acute cholecystitis

A

cholecystectomy (removal) within 1 week + IV abx

22
Q

what is ascending cholangitis

A

bacterial infection of biliary tree secondary to gallstones

23
Q

organism in ascending cholangitis

24
Q

what triad is seen in ascending cholangitis

A

charcots: fever + RUQ pain + jaundice

25
what pentad is seen in ascending cholangitis
Reynolds: hypotension + confusion + charcots triad
26
invx ascending cholangitis
USS
27
mx ascending cholangitis
IV abx and ECRP
28
what is gallstones ileus
gallstone --> fistula between gallbladder and duodenum +/- SBO
29
gallbladder abscess symptoms
prodromal illness // RUQ // swinging fever
30
what is primary sclerosing cholangitis
inflamm and fibrosis of intra and extra hepatic bile ducts
31
what condition is assoc with primary sclerosing cholangitis (PSC)
UC!!! (crohns + HIV)
32
symptoms PSC
cholestasis (jaundice, itch, raised bili + ALP) // RUQ pain // fatigue
33
invx in PSC (3)
ECRP or MCRP // pANCA // liver biopsy
34
what disease is the main risk factor for cholangiocarcinoma (bile duct cancer)
Primary sclerosing cholangitis
35
what tumour marker is raised in cholangiocarcinoma
Ca 199
36
symptoms of cholangiocarcinoma
biliary colic // anorexia // jaundice // mass in RUQ (courvoisier sign) // periumbilical lymph + left supraclavicular lymph
37
what nodes may be up in cholangiocarcinoma
periumbilica (sister mary joseph) // left supraC (virchows)