Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Stage 3 > Biliary > Flashcards

Biliary Flashcards

1
Q

Approximately how many adults in the West have gallstones and how many of these develop symptoms each year?

A

10-15%, 1-4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three types of gallstones?

A

1) Pigment (<10%)
2) Cholesterol (90%)
3) Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are pigment gallstones associated with?

A

1) Haemolysis
2) Stasis
3) Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are cholesterol gallstones associated with?

A

1) Female sex
2) Increasing age
3) Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are risk factors for developing gallstones?

A

Fair, fat, female and forty
1) Obesity
2) Female sex
3) Diabetes
4) Family history
5) Chronic loss of bile salts e.g. terminal ileal disease, Crohn’s disease
6) Oral contraceptive pill
7) Pregnancy
8) Rapid change in weight e.g. bariatric surgery
9) Chronic haemolysis e.g. sickle cell anaemia, G6PD
10) Increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are complications of gallstones that can occur in the gallbladder?

A

1) Biliary colic
2) Acute or chronic cholecystitis
3) Empyema/mucocoele
4) Mirizzi’s syndrome
5) Cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Mirizzi’s syndrome?

A

1) Rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman’s pouch
2) Presenting symptoms are similar to symptoms of cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are complications of gallstones that can occur in the bile ducts?

A

1) Obstructive jaundice
2) Pancreatitis
3) Cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are complications of gallstones that can occur in the duodenum?

A

1) Gallstone ileus
2) Bouveret’s syndrome - gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of biliary colic (gallstones)?

A

1) Colicky RUQ pain
2) Worse after eating
3) No fever
4) Murphy’s sign negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the best initial investigation for suspected gallstones?

A

Gallbladder ultrasound (ERCP invasive, would do this over liver screen even if jaundice bc suggests obstructive cause of jaundice, US fast, cheap, non-invasive, uses no radiation and gallstones often easily seen as they cast a shadow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a potential complication of biliary colic?

A

Obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does obstructive jaundice present?

A

Jaundice, dark urine, pale stools, pruiritis (cholestasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is treatment not required for biliary colic?

A

If there is no obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is treatment for biliary colic to relieve symptoms if they are recurrent or troublesome?

A

Elective cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the features of acute cholecystitis?

A

1) RUQ/epigastric pain - radiates to right shoulder tip if diaphragm is irritated
2) Fever
3) Nausea and vomiting
4) RUQ tenderness
5) Murphy’s sign is positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can happen if there is associated biliary obstruction in acute cholecystitis?

A

The patient can also get jaundice with dark urine and pale stools, however this is not a key feature of cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Murphy’s sign?

A

1) Murphy’s sign is elicited by asking the patient to take in and hold a deep breath while palpating the right subcostal area
2) If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is ascending cholangitis?

A

Bacterial infection of the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common predisposing factor to ascending cholangitis?

A

Gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the clinical features of ascending cholangitis?

A

Charcot’s triad (⅓ of patients):
1) RUQ pain
2) Fever
3) Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which condition is Charcot’s triad associated with?

A

Ascending cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Charcot’s triad?

A

1) RUQ pain
2) Fever
3) Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What other symptoms are common in ascending cholangitis if sepsis is severe?

A

1) Hypotension
2) Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the causes of ascending cholangitis?

A

1) Biliary calculi (stones) (50%)
2) Benign biliary stricture (20%) - can be congenital, post-infectious or inflammatory
3) Malignancy (10-20%) - in the gallbladder, bile duct, ampulla, duodenum or pancreas

26
Q

What will basic bloods show in ascending cholangitis?

A

1) Raised LFTs
2) Raised CRP

27
Q

What initial imaging can be used for investigating ascending cholangitis?

A

1) US abdomen - can detect bile duct dilatation but not v good at picking up stones in the mid/distal area of the biliary duct
2) CT scan - gives good anatomical detail of the biliary tree and may visualise radio-opaque stones (but poor at viewing radiolucent cholesterol stones which are the most common)

28
Q

What is the gold-standard investigation for ascending cholangitis?

A

MRCP - most accurate modality to determine disease incl. gallstones or strictures and can view almost all causes of biliary tree blockage

29
Q

What therapeutic intervention can be used for ascending cholangitis once an aetiology has been determined?

A

ERCP (Endoscopic retrograde cholangiopancreatography)

30
Q

How do you manage ascending cholangitis?

A

1) Resuscitation - IV fluids, abx, critical care depending on the presence or severity of shock and organ failure
2) Biliary drainage - may be required
3) Endoscopic drainage - ERCP, may be used for stent placement for strictures
4) Percutaneous drainage - PTC (Percutaneous transhepatic cholangiography)
5) Surgical drainage
6) Assessment and management of predisposing cause e.g. if gallstones consider cholecystectomy, if malignant stricture needs further Ix and Mx as appropriate

31
Q

What is the key feature of chronic cholecystitis?

A

Flatulent dyspepsia - stomach upset associated with the formation of gas in the stomach

32
Q

What are the features of chronic cholecystitis?

A

1) Flatulent dyspepsia
2) Vague abdominal pain
3) Nausea
4) Bloating
5) Symptoms which are worse after a fatty meal
6) Sometimes colicky-pain

33
Q

How does gallstone ileus happen?

A

1) If a gallstone is able to erode through the gallbladder wall a fistula can form between the gallbladder and small bowel (cholecystoenteric fistula)
2) If a large gallstone travels through this fistula it can get trapped in narrow areas of the bowel leading to small bowel obstruction - most commonly occurs in the terminal ileum around the ileo-caecal valve

34
Q

What imaging would you do to investigate gallstone ileus?

A

X ray

35
Q

What would an x-ray show that heavily suggests gallstone ileus?

A

1) Pneumobilia - air in the biliary tree AND
2) Dilated small bowel

36
Q

What is the epidemiology of cholangiocarcinoma?

A

1) Relatively rare cancer
2) High mortality rate - 5 year survival around 15-20%

37
Q

How does cholangiocarcinoma present?

A

Often presents late with metastases with:
1) Vague symptoms of abdominal pain - not always in RUQ
2) Jaundice
3) Anorexia
4) Weight loss
5) Abdominal mass may be felt in the RUQ = Courvoisier sign

38
Q

What is Courvoisier sign?

A

When an abdominal mass can be felt in the RUQ indicating cholangiocarcinoma

39
Q

What is the most common risk factor for cholangiocarcinoma?

A

History of gallstones or chronic cholecystitis

40
Q

What are the risk factors for cholangiocarcinoma?

A

1) History of gallstones or chronic cholecystitis
2) Smoking
3) Obesity
4) Primary sclerosing cholangitis
5) Ulcerative colitis/Crohn’s colitis
6) Oestrogens
7) Occupational exposure - pesticides, radiation, heavy metals, vinyl chloride

41
Q

Which occupational exposures are risk factors for cholangiocarcinoma?

A

Vinyl chloride, pesticides, radiation, heavy metals

42
Q

What is the gold-standard investigation for cholangiocarcinoma?

A

ERCP - most accurate investigation, can allow visualisation of the mass as well as obtain biopsies for histology (other imaging e.g. US and CT can also be used)

43
Q

Why is an x-ray worse for investigating gallstones than ultrasound?

A

1) Uses radiation
2) Only 10% of gallstones are radio-opaque

44
Q

What is the preferred method for treating high risk bile duct stones?

A

ERCP

45
Q

When is CT used?

A

To check for complications of gallstones e.g. ascending cholangitis or gallstone pancreatitis

46
Q

What is scleral icterus?

A

Jaundice of the eyes

47
Q

What is primary biliary cholangitis?

A

Autoimmune condition causing scarring and inflammation of the bile ducts, eventually leading to liver cirrhosis

48
Q

How does primary biliary cholangitis present?

A

1) Extreme fatigue
2) Itching
3) Dry skin
4) Dry eyes
5) Jaundice

49
Q

What is primary biliary cholangitis a risk factor for?

A

Hepatocellular carcinoma (poor prognosis)

50
Q

How is primary biliary cholangitis diagnosed?

A

1) Abnormal LFTs
2) Positive anti-mitochondrial antibodies
3) Abdominal ultrasound
4) Liver biopsy - inflammation and scarring

51
Q

How is primary biliary cholangitis treated?

A

Supportive
1) Ursodeoxycholic acid
2) Cholestyramine
3) Vitamin supplements
4) Liver transplantation (may recur after this)

52
Q

Which antibodies are positive in primary biliary cholangitis?

A

Anti-mitochondrial antibodies (AMA)

53
Q

What is primary sclerosing cholangitis?

A

Chronic cholestatic disorder characterised by inflammation and fibrosis of intrahepatic and extrahepatic bile ducts, resulting in multifocal biliary strctures

54
Q

How does primary sclerosing cholangitis present?

A

1) Asymptomatic with abnormal LFTs or hepatomegaly
2) Jaundice
3) RUQ pain
4) Fatigue, weight loss, fevers, sweats

55
Q

Which condition is primary sclerosing cholangitis associated with?

A

Ulcerative colitis

56
Q

How is primary sclerosing cholangitis diagnosed?

A

1) Deranged LFTs - cholestatic picture
2) Positive antibodies
3) MRCP/ERCP

57
Q

Which antibodies are positive in primary sclerosing cholangitis?

A

1) Anti-smooth muscle antibodies (anti-SMA)
2) Antinuclear antibodies (ANA)
3) Myeloperoxidase antineutrophil cytoplasmic antibodies (ANCA)

58
Q

What is seen on MRCP/ERCP in primary sclerosing cholangitis?

A

Multiple beaded biliary strictures

59
Q

Which cancer are patients with primary sclerosing cholangitis at increased risk for?

A

Cholangiocarcinoma (not related to underlying severity of biliary fibrosis)
Colorectal cancer if co-existent IBD

60
Q

How is primary sclerosing cholangitis managed?

A

1) Avoid alcohol
2) Pruritis can be managed with cholestyramine
3) Supplement fat soluble vitamins (A,D,E,K)
4) Strictures can be dilated via ERCP
5) Liver transplantation may be indicated in cases complicated by chronic liver disease and/or hepatobiliary malignancies

Stage 3 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions