Biliary Diseases Flashcards
Why are Crohn’s patients at risk of gallstone disease?
With ileal disease, bile acid loss increases, bile acid pool decreases leading to increased free cholesterol in bile. Can also cause diarrhea and steatorrhea.
Why does ileal disease cause diarrhea?
Decreased FGF19 secretion by TI cells leads to increased bile acid creation, which will reach the colon and cause diarrhea.
Do fibrates increase or decrease the risk of gallstone disease?
Increase, because it will decrease the bile acid pool and lead to cholesterol supersaturated bile.
Mirizzi Syndrome and treatment
Compression of the common hepatic duct by impacted stone in the cystic duct. Treat with cholecystectomy.
How to treat Salmonella Typhi carrier
Cholecystectomy. Antibiotics are ineffective. Patients are at risk for gallbladder carcinoma.
How to treat type III biliary cysts?
Choledochoceles (which are distal CBD cysts) can be treated with sphincterotomy.
What is APBJ?
Anomalous pancreaticobiliary junction. Long connection of panc and biliary system causes reflux of pancreatic juice into bile ducts. Increases risk of cholangiocarcinoma and gallbladder carcinoma. Consider prophylactic cholecystectomy
Black vs Brown Gallstones
Black are usually caused by old age, hemolysis, TPN, cirrhosis.
Brown usually caused by stasis and infection. Seen in recurrent pyogenic cholangitis.e
How does rapid weight loss cause gallstones
Decreased fat stimulation with CCK causes gallbladder stasis, also reduced synthesis of bile acids (higher free cholesterol in bile)
Very strong risk factors for choledocholithiasis?
Strong risk factors for choledocholithiasis?
Bili > 4, cholangitis, stone on imaging
Bili 1.8-4, Dilated CBD >6mm
If both strong predictors, risk is high.
How to prevent cholecystitis for bariatric surgery patients?
High fat diet, consider ursodiol
What is Bouvaret Syndrome?
Fistula between gallbladder and duodenum causing duodenal obstruction
What is recurrent pyogenic cholangitis?
Disease seen in predominantly south East Asians with recurrent brown pigmented stones in intrahepatic bile ducts causing recurrent cholangitis. Usually left and central ducts.
