Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Summer FDTN Exam 5 > Biliary disease > Flashcards

Biliary disease Flashcards

1
Q

What would happen if you didnt have a gallbladder

A

Release of digestive enzymes would not be timed as nicely, but eventually you can return to eating fatty foods

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

What is bile

A

Fluid secreted from liver (500ml/d) and stored in gallbladder
Made up of water, electrolytes, bile salts, phospholipids,

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

What is cholelithiasis

A

Stones in the gallbladder AKA gallstones

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

What is cholecystitis

A

Inflammation of the gallbladder

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

What is choledocolithiasis

A

Stones in the CBD

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

What is cholangitis

A

Inflammation of the bile ducts

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

What is Cholestasis

A

disruption of bile flow, regardless of cause

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

RF for cholelithiasis are

A 
Female 
Fluffy (obese) 
Forty (age >40) 
Fertile (pregnancy) 
Rapid weight loss 
Estrogens, BCP 
Ethnicity (native american, hispanic, caucasian)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the types of gallstones

A 
Cholesterol stones (MC) 
Pigment stones (calcium, bilirubin, proteins)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can cholelithiasis present

A

ASx (MC)

Sx (biliary colic, or with complications)

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

What are complications of Cholelithiasis

A

Acute cholecystitis
Acute choledocolithiasis
Ascending cholangitis
Acute pancreatitis

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

How do you diagnose cholelithiasis

A

*US (initially)- can show gallstones, wall thickening, pericholecystic fluid
CT Abdomen- more expensive, more radiation, less Sn, but will show majority of stones
Abd XR has limited value in Dx gallstones

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

How do you manage asymptomatic cholelithiasis

A

If incidental finding and ASx, you should NOT do a CCY

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

How do you manage Symptomatic cholelithiasis

A

Cholecystectomy (CCY)

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

What is biliary colic

A

Temporary obstruction of cystic duct
MCC by gallstones which cause pressure in gallbladder to rise= pain
As gallbladder relaxes, obstruction is relieved
NO INFLAMMATION!!*****

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

How does biliary colic present

A

Dull, constant RUQ pain w/ possible radiation to R shoulder blade
MC after a fatty meal
Associated nausea, vomiting, and diaphoresis
Sx are TEMPORARY**, 4-6 hours max

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

What if they have biliary colic pain but it lasts >6 hours

A

This is acute cholangitis! Treat it more urgently

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

On PE for biliary colic you may find

A

They are NOT acutely ill
Vital signs are normal (no fever or tachy)
NO jaundice
NO scleral icterus
+/- RUQ ttp, but NO rebound, NEG murphy’s sign

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

What labs should you get to eval biliary colic

A

CBC
LFT
Amylase and lipase
(will all be normal)

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

How do you diagnose biliary colic

A

*US- expect to see gallstones or sludge, which is causing the temp obstruction

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

How do you manage biliary colic

A

Prophylactic CCY to prevent recurrent Sx and complications
MUST have r/o alternate diagnoses bc your workup is frequently normal. Gall stones could be present, but they may not be the root of the Sx

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

What is biliary dyskinesia

A

Functional gallbladder disorder;

No sludge, no stones, no inflammation. Gallbladder just doesn’t function correctly!

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

Consider biliary dyskinesia in a patient who

A

has NO gall stones or sludge on US

Has normal labs (CBC, LFT, Am, Lip)

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

How can you diagnose biliary dyskinesia

A

HIDA scan with CCK!
Inject HIDA, which should normally be excreted in bile and taken up by gallbladder w/in 30 min. Then measure radioactivity in gallbladder
Give CCK to stimulate gallbladder to contract and measure EF, but NOT if the pt has stones!
Abnormal gallbladder motility is EF <35-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do you manage biliary dyskinesia
CCY if biliary dyskinesia and: Biliary Sx HIDA w/ CCK EF <35-40% that reproduces Sx R/o PUD, gastritis, GERD cardiac ischemia
26
What is acute cholecystitis
Acute inflammation of the gallbladder due to sustained obstruction of cystic duct MCC is cholesterol stones
27
What history findings point you to acute cholecystitis
Steady, severe RUQ pain +/- right shoulder radiation Occurs s/p fatty meal Associated nausea, vomiting, diaphoresis, fever Sx persist >4-6 hours! History of biliary colic
28
On PE for acute cholecystitis you may find
``` Ill appearing fever, tachycardia NO jaundice NO scleral icterus RUQ ttp w/ palpablt, tender gallbladder +/- rebound and guarding *Positive murphy's sign ```
29
What are complications of acute cholecystitis
``` Gangrene, esp. if old, immunosuppressed, or delayed treatment Perforation Generalized peritonitis Cholecystoenteric fistula Gallstone ileus ```
30
What labs should you get for acute cholecystitis
CBC: elevated WBC w/ left shift** LFT: normal, mils ALT/AST, alk phos, and bili elevation UA: elevated urobilinogen Pancreatic enzymes: mild elevation of amylase
31
If alk phos and bilirubin are significantly elevated when you suspect Acute cholecystitis, you must
rule out Cholangitis! | *Alk phos and Bilirubin= obstruction!
32
How do you diagnose acute cholecystitis
*US- may see gallstones, thick wall, pericholecystic fluid, + sonographic murphy's sign HIDA scan: confirm Dx if the US was not definitive- will show failure of GB to fill
33
How do you manage acute cholecystitis
Admit Analgesics (ketorolac, morphine, meperidine) NPO IVF, electrolytes IV abx (cipro, flagyl *Early CCY if healthy, low risk (ASA class I-II)- do it when they are not acutely inflammed
34
What is criteria for emergent CCY
IF severe complication (gangrene, perforation, peritonitis) | Clinical deterioration despite supportive therpay
35
What is the ASA classification system
``` I: normal, healthy pt II: mild systemic dz III: severe systemic dz IV: severe systemic dz that is life threatening V: will not survive w/o surgery VI: brain dead, organ donor surgery ```
36
How do you manage high risk acute cholecystitis patients
Supportive therapy Consult specialist for risk vs benefir of CCY If therapy fails, consider cholecystostomy tube to decompress
37
What is chronic cholecystitis
Chronic inflammation of the gallbladder associated with mechanical irritation (gallstones) or repeat acute cholecystitis Usually diagnosed s/p CCY when looking at histology
38
What is acalculous cholecystitis
Similar to acute cholecystitis but no gallstones, and may have jaundice Common in critically ill patients (associated stasis and ischemia) Worse than calculous cholecystitis
39
How do you diagnose acalculous cholecystitis
US LFT CBC
40
PROMPT Tx of acalculous cholecystitis includes
CCY vs. Cholecystostomy (CCY best)
41
Why do you want to be prompt about treating acalculous cholecystitis
bc secondary infection of the gallbladder is common; | Check blood cultures, start broad spectrum Abx, and prevent gallbladder gangrene!
42
What is choledocolithiasis
Stone in the CBD that blocks bile flow and caused jaundice*
43
History findings that indicate choledocolithiasis are
``` RUQ or epigastric pain N/v Sx similar to PUD Jaundice*, pruritis, tea colored urine, light colored stool (look for Hx of biliary colic) ```
44
PE for UNcomplicated choledocolithiasis (no cholangitis) shows
``` mild discomfort afebrile, no tachy, no hypotension Jaundice* Scleral icterus* +/- RUQ ttp, no peritoneal signs ```
45
What findings would make you suspect cholangitis with choledocolithiasis
Fever Jaundice Leukocytosis Prominent RUQ ttp
46
What labs should you get for uncomplicated choledocolithiasis
CBC (no leukocytosis) LFT (if w/ cholestasis, high CONjugated bili and high Alk Phos) Pancreatic enzymes (normal)
47
What imaging can you get for choledocolithiasis
``` RUQ US (first test)- may see CBD stone, dilated CBD, or stones in the GB If uncertain, can get an MRCP ```
48
What does MRCP show
Biliary and pancreatic ducts | Confirms diagnosis of CBD stone
49
How do you manage choledocolithiasis
Remove stone to prevent cholangitis or pancreatitis +/- prophylactic Abx (cipro, flagyl) ERCP as therapeutic test to remove stone, insert stent, and perform sphincterotomy Then CCY
50
When is it ok to perform an ERCP in choledocolithiasis
When you know you will have to treat | Because of how invasive it is, do not do it just for diagnostic purpose
51
What is ascending cholangitis
Infection of the biliary tract, MC in CBD- like a pond of water just sitting Associated with biliary obstruction Bacteria infects bile (ascending infection from duodenum) AKA: Pus under Pressure! so, this is an emergency!
52
What history findings point you to ascending cholangitis
RUQ epigastric pain jaundice fever Hx of biliary colic or disease
53
On ascending cholangitis PE you may find
``` acutely ill appearing, diaphoretic fever, tachycardia, hypotension jaundice scleral icterus RUQ ttp, guarding AMS ```
54
Acute presentation of ascending cholangitis is
**Charcot's triad: Fever, RUQ pain, jaundice **Reynolds pentad: Fever, RUQ pain, Jaundice, hypotension, mental status changes Signs of peritonitis and sepsis
55
What are some lab findings in acute cholangitis
``` Leukocytosis (>20K) LFT: elevated Conjugated bili and alk phos** indicate cholestasis Pancreatic enzymes: nl-mild high UA: high urobilinogen Blood cultures may show sepsis ```
56
How do you diagnose ascending cholangitis
US | MRCP (CBD stone and dilation)
57
How do you manage ascending cholangitis
``` Admit Consult GI NPO, IVF Broad spectrum Cipro+Flagyl MUST relieve obstruction ERCP w/ sphincterotomy and stone extraction Follow with CCY ```
58
How does an ERCP treat ascending cholangitis
Sphincterectome Stone extraction from CBD Relieve obstruction +/- stent
59
If you suspect biliary disease, what diagnostics do you order to r/o others
CBC w/ diff: r/o infection Amylase/lipase: r/o pancreatitis (mild bump with acute biliary dz) LFT: high alk phos and conjugated bili= cholestasis 2/2 obstruction. ALT/AST with transient elevations US MRCP: helpful w/ dx stones/obstruction in CBD when US non-diagnostic
60
Additional diagnostics in biliary disease are
HIDA scan to confirm cystic duct obstruction. Add CCK to measure EF for biliary dyskinesia ERCP: relieve CBD obstruction
61
What is primary biliary cirrhosis
Autoimmune destruction of small intrahepatic bile ducts causing cholestasis Leads to cirrhosis and liver failure MC in females 35-60
62
How does primary biliary cirrhosis present
*Fatigue, pruritis before jaundice (2/2 bile getting into circulation) Arthritis, RUQ pain, CREST Sx
63
If a patient comes in with itching, what labs do you get
Conjugated bili Alk Phos ALT, AST (pruritis is usually skin, but need to r/o bile in the circulation!)
64
What labs should you get to eval primary biliary cirrhosis
``` LFT (high alk phos, then high Con bili; high GGT) *Anti-mitochondrial antibody (AMA) ANA IgM HLD ```
65
What is GGT
a very sensitive liver marker of inflammation | If alk phos is high and you don't know whether it is from liver or bone, GGT helps tell you its liver!
66
How do you diagnose primary biliary cirrhosis
Liver biopsy! | Confirm dx and stage dz
67
How do you manage primary biliary cirrhosis
Urso (med to help w/ stasis) | DEXA to monitor bone density
68
What is primary sclerosing cholangitis
Inflammation/fibrosis of medium and large intra/extra hepatic ducts Progress to cirrhosis (survival is 10-12 yrs s/p dx) MC in men
69
Sx of primary sclerosing cholangitis are
*Fatigue, pruritis after jaundice, steatorrhea
70
Complications of primary sclerosing cholangitis are
``` Biliary stricture Cholangitis Cholangiocarcinoma Gallbladder cancer Colon cancer ```
71
How do you diagnose primary sclerosing cholangitis
LFT have cholestatic pattern (high alk phos and conj bili) *P-ANCA, ASMA, ANA, IgM ERCP: Dx and therapeutic MRCP: will see *multifocal stricturing w/ intra/extra hepatic ductal dilation* Liver biopsy is usually non-diagnostic
72
How do you manage primary sclerosing cholangitis
Monitor bone density Manage biliary strictures with ERCP (dilate/stent) Monitor for complications Liver transplant with advanced disease
73
What is Gilbert's syndrome
Deficiency in enzyme to conjugate bilirubin in the liver Leads to *Unconjugated hyperbilirubinemia withOUT hemolysis They are totally ASx
74
Labs for Gilbert's syndrome show
High unconjugated bili | Normal CBC, blood smear, reticulocytes, all other LFT are normal
75
RF for gallbladder cancer are
Cholelithiasis Gallbladder polyps >1cm Salmonella infection
76
How does gallbladder cancer present
ASx or looks just like cholelithiasis | Sx can suggest malignancy (anorexia, wt loss)
77
What is Cholangiocarcinoma
Adenocarcinoma of bile ducts, associated with PSC and choledochal cysts
78
How does cholangiocarcinoma present
``` *Jaundice upper abd pain anorexia weight loss pruritis ```
79
Cholangiocarcinoma labs show
Cholestasis: high conj bili and alk phos | Elevated CA-19-9 (pancreatic cancer marker)
80
What is ampullary cancer
Cancer of ampulla of vater, where CBD and pancreatic duct meet Associated w/ familial adenomatous polyposis and HNPCC
81
How does ampullary cancer present
*Obstructive jaundice occult GIB w/ microcytic anemia abdominal pain

Summer FDTN Exam 5 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions