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Clin Med: GI (block 3) > Biliary Disorders > Flashcards

Biliary Disorders Flashcards

1
Q

What conditions can result from gallstones?

A
  • Biliary colic
  • Acute Cholecystitis
  • Ascending cholangitis
  • Gallstone pancreatitis
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2
Q

90% of gallstones in Western countries are made of…

A

cholesterol

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3
Q

Cholelithiasis RFs

A
  • FHx of cholecystectomy in 1st-degree relative
  • female
  • obesity
  • rapid weight loss
  • childbearing
  • incr age
  • ethnicity - Native American (Pima Indian), Scandinavian
  • postmenopausal estrogen
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4
Q

Cholelithiasis is related to interplay of…

A
  • genetics
  • too much cholesterol
  • impaired gallbladder motility
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5
Q

Cholelithiasis is associated with…

A

systemic metabolic disturbances, including insulin resistance, visceral adiposity, obesity, type 2 DM, the metabolic syndrome & ischemic heart dz

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6
Q

Overarching cholelithiasis pathophys

A

There is so much cholesterol in the bile, that it forms stones (precipitates)

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7
Q

Cholelithiasis S/S

A

most pts w/ gallstones are asymptomatic

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8
Q

Biliary colic may occur…

A
  • in upper abdo
  • in RUQ
  • usually after meals
  • nausea &/or vomiting
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9
Q

Cholelithiasis PE

A
  • Usually unremarkable w/ simple gallstones
  • May have RUQ tenderness during biliary colic
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10
Q

Cholelithiasis Labs

A
  • blood tests if suspected gallstone dz to assess for complicated dz & help rule out other causes
  • blood tests may be normal even in pts w/ symptomatic gallstones
  • liver function tests
  • serum lipase
  • CBC
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11
Q

Cholelithiasis Imaging

A
  • RUQ US the test of choice
  • HIDA scan: Hepatobiliary IminoDiacetic Acidscan- radioactive tracer injected that highlights gallbladder function
  • ERCP/MRCP can be used to detect stones in the bile duct
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12
Q

Cholelithiasis Tx

A
  • asymptomatic gallstones, routine tx not recommended
  • Provide analgesia w/ NSAIDS/opiates**
  • Avoid food/drink triggers
  • Oral bile acid to dissolve stones (doesn’t work very well)
  • Cholecystectomy
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13
Q

Describe Acute Cholecystitis

A

Acute inflammation of the gallbladder most commonly assoc. w/ obstruction of the cystic duct by gallstones or biliary sludge

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14
Q

Acute Cholecystitis pathophys

A

Occurs when a stone becomes impacted in the cystic duct & inflammation develops behind the obstruction

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15
Q

Acute Cholecystitis S/S

A
  • usually begins w/ attack of biliary colic characterized by:
    –> severe, episodic, epigastric or RUQ pain, often radiating to the back
    –> follows food intake/onset is often at night
    –> typically accompanied by N/V
  • pain of acute cholecystitis persists & localizes to RUQ
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16
Q

Acute Cholecystitis PE

A
  • tenderness/guarding of RUQ
  • palpable mass may be present after 24 hrs
  • Murphy sign is arrest of inspiration while palpating patient’s gallbladder during deep inspiration
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17
Q

Acute Cholecystitis labs

A
  • WBC high
  • Incr total serum bilirubin
  • AST/ALT/Serum amylase may also be moderately elevated
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18
Q

Acute Cholecystitis Imaging

A
  • HIDA scan: useful in demonstrating an obstructed cystic duct
  • RUQ abdo US
    –>May show gallstones
19
Q

Acute Cholecystitis Tx

A
  • Initial medical tx includes nothing by mouth, IV fluids, electrolyte correction, antibiotics, & analgesics
  • Cholecystectomy (generally laparoscopic)
    –> Performed w/n 24hrs after admission to the hospital for acute cholecystitis b/c of the high risk of recurrent attacks
20
Q

What is Choledocholithiasis?

A

Obstruction of the common bile duct

21
Q

Choledocholithiasis complications

A

acute pancreatitis & cholangitis

22
Q

Bile duct stones usually originate in the…

A

gallbladder but may form spontaneously in the common bile duct after cholecystectomy

23
Q

Choledocholithiasis S/S

A

Pain is similar to biliary colic, but lasts longer (>5 hours)

24
Q

Choledocholithiasis PE

A
  • Often reveals pain to palpation of the RUQ
  • Courvoisier sign is a palpable gallbladder due to CBD obstruction
25
Q

Choledocholithiasis Dx

A
  • US
  • ERCP or MRCP is more sensitive/specific
  • CBC- elevated WBC
  • Elevated Bilirubin
  • Elevated liver enzymes
26
Q

Choledocholithiasis Tx

A
  • ERCP to remove the stone
  • Laparoscopic common bile duct exploration if gallbladder being removed at the same time
27
Q

What is Ascending Cholangitis?

A

Inflammation of the biliary tree
- bacterial infx 2ndary to biliary stasis or obstruction

28
Q

What infecting organisms can causes ascending cholangitis?

A

gram-negative rods
- E. coli & Klebsiella

29
Q

Ascending Cholangitis can also be caused by… & describe.

A

biliary stricture
- a narrowing of the bile duct due to surg, mass, inflammation

30
Q

Ascending Cholangitis Pathophys

A
31
Q

Ascending Cholangitis

A
  • Severity ranges from a self-limited to a potentially life-threatening dz req urgent management
    –>classic symptomsinclude the Charcot triad of fever, abdominal pain, & jaundice.
  • Severe cases may have the Reynold pentad, which includes the Charcot triad + septic shock & an AMS
32
Q

Ascending Cholangitis Dx

A
  • An US/CT/MRCP may show dilated common bile duct
  • CBC- elevated WBC
  • Elevated Bilirubin
  • Elevated liver enzymes
  • Blood cultures
33
Q

Ascending Cholangitis Tx

A
  • Empiric BSAbx

3 major approaches to biliary drainage
- Endoscopic: ERCP
- percutaneous transhepatic
- surgical

34
Q

What is Primary Sclerosing Cholangitis?

A

a chronic liver dz characterized by inflammation, destruction, fibrosis, progressive narrowing, & saccular dilatations of the bile ducts, leading to cholestasis

35
Q

Primary Sclerosing Cholangitis Etiology

A

unclear, but could be genetic or autoimmune

36
Q

Primary Sclerosing Cholangitis affects which population?

A

middle aged males w/ IBD

37
Q

Primary Sclerosing Cholangitis will progress to

A

Liver failure & premature death w/o liver transplant

38
Q

Primary Sclerosing Cholangitis pathophys

A
39
Q

In Primary Sclerosing Cholangitis, what % of pts are asymp at initial presentation?

A

50%

40
Q

What are the symptoms w/ primary sclerosing cholangitis if there are any?

A
  • pruritus
  • RUQ pain
  • fatigue
  • weight loss
  • confusion
  • jaundice
41
Q

Primary Sclerosing Cholangitis PE

A
  • normal in about 50% at first
  • hepatomegaly, splenomegaly, & jaundice
42
Q

Primary Sclerosing Cholangitis Dx

A

MRCP: Shows characteristic segmental fibrosis of the bile ducts

43
Q

Primary Sclerosing Cholangitis Tx

A
  • Liver transplant*
  • Balloon dilation of bile duct strictures
  • Pts at higher risk for cholangiocarcinoma (bile duct cancer)

Clin Med: GI (block 3) (8 decks)

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