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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
Choledocholithiasis Dx
- US - ERCP or MRCP is more sensitive/specific - CBC- elevated WBC - Elevated Bilirubin - Elevated liver enzymes
26
Choledocholithiasis Tx
- ERCP to remove the stone - Laparoscopic common bile duct exploration if gallbladder being removed at the same time
27
What is Ascending Cholangitis?
Inflammation of the biliary tree - bacterial infx 2ndary to biliary stasis or obstruction
28
What infecting organisms can causes ascending cholangitis?
gram-negative rods - E. coli & Klebsiella
29
Ascending Cholangitis can also be caused by... & describe.
biliary stricture - a narrowing of the bile duct due to surg, mass, inflammation
30
Ascending Cholangitis Pathophys
31
Ascending Cholangitis
- Severity ranges from a self-limited to a potentially life-threatening dz req urgent management --> classic symptoms include 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
Ascending Cholangitis Dx
- An US/CT/MRCP may show dilated common bile duct - CBC- elevated WBC - Elevated Bilirubin - Elevated liver enzymes - Blood cultures
33
Ascending Cholangitis Tx
- Empiric BSAbx 3 major approaches to biliary drainage - Endoscopic: ERCP - percutaneous transhepatic - surgical
34
What is Primary Sclerosing Cholangitis?
a chronic liver dz characterized by inflammation, destruction, fibrosis, progressive narrowing, & saccular dilatations of the bile ducts, leading to cholestasis
35
Primary Sclerosing Cholangitis Etiology
unclear, but could be genetic or autoimmune
36
Primary Sclerosing Cholangitis affects which population?
middle aged males w/ IBD
37
Primary Sclerosing Cholangitis will progress to
Liver failure & premature death w/o liver transplant
38
Primary Sclerosing Cholangitis pathophys
39
In Primary Sclerosing Cholangitis, what % of pts are asymp at initial presentation?
50%
40
What are the symptoms w/ primary sclerosing cholangitis if there are any?
- pruritus - RUQ pain - fatigue - weight loss - confusion - jaundice
41
Primary Sclerosing Cholangitis PE
- normal in about 50% at first - hepatomegaly, splenomegaly, & jaundice
42
Primary Sclerosing Cholangitis Dx
MRCP: Shows characteristic segmental fibrosis of the bile ducts
43
Primary Sclerosing Cholangitis Tx
- 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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