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Foundations III GI (Cholley) > Biliary Disease > Flashcards

Biliary Disease Flashcards

1
Q

What are RFs for cholelithiasis?

A

“Four F’s” = female, fluffy, forty, fertile

Pregnancy
Rapid wt loss
Ethnicity

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2
Q

What is the MC type of stone seen in cholelithiasis?

A

Cholesterol!

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3
Q

What is the clinical presentation of cholelithiasis?

A

Majority asx

Biliary colic

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4
Q

What are complications of cholelithiasis?

A

Cholecystitis
Choledocholithiasis
Cholangitis
Pancreatitis

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5
Q

What imaging is used for dx of cholelithiasis?

A

U/S = TOC!

Abd xray

CT abd

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6
Q

How do you treat symptomatic cholelithiasis?

A

CCY

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7
Q

Describe biliary colic

A

Temporary obstruction of cystic duct

Caused by gallstone usually

Increased pressure –> pain

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8
Q

What is the clinical presentation of biliary colic?

A

Dull RUQ pain w/ radiation to R shoulder blade

N/V, diaphoresis

Sx are temporary! < 4-6hrs

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9
Q

What can trigger biliary colic?

A

Fatty meal

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10
Q

What labs are used in biliary colic?

A

CBC
LFTs
Amylase/lipase

ALL NORMAL!

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11
Q

What imaging can you use to dx biliary colic?

A

U/S: TOC! Gallstones or sludge expected

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12
Q

How do you treat biliary colic?

A

Prophylactic CCY

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13
Q

When should you consider biliary dyskinesia (functional gallbladder disorder)?

A

In patient presenting w/ typical biliary colic, but have no gallstones or sludge

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14
Q

What imaging should be considered in biliary dyskinesia?

A

HIDA w/ cholecystikinin (CCK)

*Don’t give CCK if gallstones present (start w/ U/S to r/o)

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15
Q

How do you treat biliary dyskinesia?

A

CCY when criteria is met:

Biliary sx
HIDA w/ CCK EF < 35-40%
Other dx r/o

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16
Q

What causes acute cholecystitis?

A

Sustained obstruction of the cystic duct

MC caused by cholesterol stones

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17
Q

What is the clinical presentation of acute cholecystitis?

A

Severe RUQ pain +/- radiation to right shoulder/flank

N/V, diaphoresis, fever

Sx persistent! > 4-6hrs

Hx of biliary colic

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18
Q

What does acute cholecystitis look like on PE?

A

Ill appearing
Fever, tachy
RUQ tenderness
+ Murphy’s sign

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19
Q

What are complications of acute cholecystitis?

A 
Gangrene (20%)
Perforation 
Peritonitis 
Fistula 
Gallstone
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20
Q

What labs are used for the dx of acute cholecystitis?

A

Elevated WBC w/ left shift

+/- elevation of AST/ALT, alk phos, bilirubin

UA: elevated urobilinogen

+/- elevation of amylase

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21
Q

What imaging is used to dx acute cholecystitis?

A

U/S: TOC! Presence of gallstones

HIDA: confirms dx

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22
Q

How do you treat acute cholecystitis?

A

NPO, IVF, analgesia, IV abx

Early cholecystectomy

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23
Q

What abx can be used for tx of acute cholecystitis?

A

Single agent:
Pipercillin tazobactam
Ampicillin sulbactam
Ticarcillin clavulanate

Combo:
Ceftriaxone + metronidazole
OR cipro + metronidazole

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24
Q

What is chronic cholecystitis associated w/?

A

Mechanical irritation from gallstones or repeated episodes of acute cholecystitis

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25
Q

What condition is common in critically ill patients & is associated w/ stasis & ischemia?

A

Acalculous cholecystitis

26
Q

How does acalculous cholecystitis present?

A

similar to acute cholecystitis except no gallstones present

27
Q

What imaging & labs are used for dx of acalculous cholecystitis?

A

U/S
LFTs
CBC

28
Q

How do you treat acalculous cholecystitis?

A

CCY vs cholecystostomy

If secondary infection of gallbladder occurs –> abx

29
Q

What is the clinical presentation of choledocholithiasis?

A

Biliary pain (RUQ or epigastric, N/V)

May be asx

Jaundice: pruritis, tea urine, light colored stool

Hx of biliary colic

30
Q

What does choledocholithiasis look like on PE?

A

Jaundice, icterus

+/- RUQ tenderness

31
Q

If choledocholithiasis presents with fever, jaundice, leukocytosis, & more prominent tenderness, what should you think?

A

Cholangitis!

32
Q

What labs are used for dx of choledocholithiasis?

A

CBC

LFTs: increased conjugated bilirubin & alk phos

Amylase/lipase

33
Q

What imaging is used for the dx of choledocholithiasis?

A

RUQ U/S = TOC! CBD stone, dilated CBD, gallstones

If dx uncertain –> MRCP

34
Q

How do you treat choledocholithiasis?

A

Removal of stones

Prophylactic abx

ERCP (preferred therapeutic test)

Cholecystectomy to follow

35
Q

What is ascending cholangitis associated w/?

A

Biliary obstruction

Bile infected w/ bacteria

36
Q

How does ascending cholangitis present?

A

RUQ/epigastric abd pain

Jaundice

Fever

Hx of biliary colic

37
Q

What does ascending cholangitis look like on PE?

A

Ill appearing, diaphoretic
Fever, tachy, hypotension
Jaundice, icterus
MSC

38
Q

What is the most acute presentation for ascending cholangitis? AKA Charcot’s triad

A

Fever/chills
RUQ pain
Jaundice

39
Q

What is Reynold’s Pentad?

A

Charcots triad + hypotension & MSC

40
Q

What labs are used for dx of ascending cholangitis?

A

CBC: leukocytosis

LFTs: cholestasis (elevated conjugated bili & alk phos)

+/- elevated pancreas enzymes

UA: elevated urobilinogen

Blood cultures

41
Q

What imaging is used for dx of ascending cholangitis?

A

U/S

MRCP: CBD dilation & stone

42
Q

How do you treat ascending cholangitis?

A

NPO, IVF

Abx for Gram+ & Gram- :
Ceftrazone + metronidazole
Cipro + metronidazole
Piperacillin/tazobactam

43
Q

What procedures are used for ascending cholangitis?

A

Relief of biliary obstruction is imperative!!

ERCP w/ sphincterotomy & stone extraction

F/u w/ CCY

44
Q

What are characteristics of primary biliary cirrhosis?

A

Females
35-60yo
Causes cholestasis

45
Q

What is the clinical presentation of PBC?

A

Fatigue

Pruritis (before jaundice)

46
Q

What labs are used for dx of PBC?

A

LFTs: elevated alk phos & GGT

Anti-mitochondrial antibody (AMA) = hallmark!!

ANA

IgM

HLD

47
Q

What confirms the dx & stages PBC?

A

Liver bx!

48
Q

How do you treat PBC?

A

Urso

DEXA (increased risk of osteoporosis)

49
Q

How does primary sclerosing cholangitis (PSC) present?

A

Fatigue

Pruritis (after jaundice)

50
Q

What are complications of PSC?

A 
Biliary stricture
Cholangitis
Cholangiocarcinoma
Gallbladder CA
Colon CA (if IBD present)
51
Q

What labs are used for dx of PSC?

A

LFTs

ANCA, ASMA, ANA, IgM

52
Q

What imaging is used for dx of PSC?

A

ERCP (dx & therapeutic)

MRCP: multifocal stricturing w/ intrahepatic/extrahepatic dutal dilation

53
Q

How do you treat PSC?

A

Monitor bone density

Manage biliary strictures w/ ERCP

Liver transplant if advanced

54
Q

What is Gilbert’s syndrome?

A

Deficiency in enzyme for glucuronidation of bilirubin in liver

55
Q

When should you suspect Gilbert’s syndrome?

A

Unconjugated hyperbilirubinemia in absence of hemolysis

56
Q

What are RFs for gallbladder CA?

A

Cholelithiasis
Gallbladder polyps > 1cm
Salmonella

57
Q

How does gallbladder CA present?

A

Can be indistinguishable from cholelithiasis

May be asx

58
Q

How does cholangiocarcinoma (adenocarcinoma of the bile ducts) present?

A

Jaundice
Upper abd pain
Anorexia, wt loss
Pruritis

59
Q

What labs are used to dx cholangiocarcinoma?

A

Labs show cholestasis
(elevated conjugated bili & alk phos)

Elevated CA 19-9

60
Q

How does ampullary cancer present?

A

Obstructive jaundice**MC

Occult GIB w/ microcytic anemia

Abd pain

61
Q

What is ampullary CA associated w?

A

FAP & HNPCC

Foundations III GI (Cholley) (10 decks)

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