Biliary Disorders Flashcards
gallstones due to increased circulating cholesterol OR bile over-concentration from incomplete or infrequent emptying
cholelithiasis
what are gallstones mostly composed of?
cholesterol
a patient presents with RUQ pain + tenderness that is worse with fatty, greasy, and large meals, peaks 30 mins postprandial and causes substernal chest pain and radiates to right scapula, flank, or shoulder. Dx?
cholelithiasis
pain that comes and goes
biliary colic
what can be a clinical finding in cholelithiasis under the RUQ costal margin?
murphy sign; inspiration stops due to deep palpation
what is the 1st line imaging for suspected cholelithiasis?
RUQ ultrasound
what is the treatment of choice for cholelithiasis in symptomatic patients?
laparoscopic cholecystectomy
what 2 pain meds can be used for cholelithiasis?
NSAIDs
dicyclomine (anticholinergic)
during which trimester is preferred for a laparoscopic cholecystectomy in a pregnant patient with symptomatic cholelithiasis?
2nd trimester
what are 4 indications for a prophylactic cholecystectomy in patients with asymptomatic cholelithiasis?
calcified gallbladder
gallstones > 3cm in diameter
LITH gene
bariatric / cardiac transplant candidates
what treatment can be used for cholelithiasis to dissolve small cholesterol stones and is useful to reduce the risk of stone formation during rapid weight loss?
ursodeoxycholic acid
inflammation and infection within the gallbladder due to a stone becoming impacted in the cystic duct and inflammation develops behind the obstruction
acute cholecystitis
what is the most common cause of acute cholecystitis?
cholelithiasis
a patient presents with diaphoresis, N/V/D, acute unrelenting and severe epigastric/RUQ pain postprandial. on physical exam, patient is guarding and positive murphy sign with a fever. Dx?
acute cholecystitis
what sign will indicate worsening obstructive pathology in a patient with acute cholecystitis?
jaundice
what labs are likely seen in acute cholecystitis? (2)
leukocytosis
mildly elevated AST/ALT
what lab results can indicate worsening obstructive pathology in acute cholecystitis?
elevated bilirubin
elevated alk phos
what is the 1st line study for acute cholecystitis? what will it show (3)?
transabdominal ultrasound
double wall sign
pericholecystic fluid
sonographic murphy sign
what imaging can be used for acute cholecystitis if US results are negative, and is useful in diagnosing acalculous cholecystitis?
HIDA scan
what is the medical management for acute cholecystitis? (4)
NPO
IV hydration
pain control (NSAIDs, morphine, hydromorphone, opiates)
ceftriaxone + metronidazole
what is the surgical treatment/treatment of choice for acute cholecystitis?
laparoscopic cholecystectomy
what is the treatment of choice for acute cholecystitis if a patient is too high risk for surgery?
cholecystostomy tube + antibiotics
when do cholecystitis complications occur most?
when gallbladder cannot be removed
chronic inflammation of the gallbladder due to repeated episodes of acute cholecystitis or irritation of the gallbladder by stones
chronic cholecystitis
what is the treatment of choice for chronic cholecystitis?
laparoscopic cholecystectomy
a stone obstructing flow within the common bile duct proximal to or distal to the pancreatic duct
choledocholithiasis
a patient presents with jaundice, biliary colic, referred pain, N/V/D, and acholic stools. on physical exam, they have RUQ +/- MEG tenderness to palpation. Dx?
choledocholithiasis
what sign indicates post-hepatic obstruction of the bile duct?
acholic stools
what will labs show in a patient with choledocholithiasis? (4)
significantly elevated AST/ALT
elevated bilirubin
elevated alk phos
elevated amylase + lipase
elevated amylase and lipase in choledocholithiasis indicates what?
secondary pancreatitis
what is the 1st line imaging study for choledocholithiasis?
transabdominal ultrasound
what is the diagnostic and treatment modality of choice with confirmed or high-risk bile duct stone in choledocholithiasis?
endoscopic retrograde cholangiopancreatography (ERCP)
what size common bile duct is suggestive of choledocholithiasis?
> 6mm
bacterial infection of the biliary tract that is most commonly caused by organisms ascending from the duodenum during episodes of biliary obstruction
acute cholangitis
a patient presents with severe, episodic RUQ pain persisting for hours, fever, and jaundice. Dx?
cholangitis (charcot triad)
a patient presents with severe, episodic RUQ pain persisting for hours, fever, jaundice, AMS, and hypotension. Dx?
suppurative cholangitis (reynolds pentad)
what labs will be present in a patient with cholangitis? (5)
significantly elevated AST/ALT
elevated bilirubin
elevated alk phos
elevated amylase + lipase
leukocytosis
what is the 1st line diagnostic for cholangitis?
transabdominal US
what is the initial treatment for all patients with cholangitis? (3)
IV fluids
analgesics
ciprofloxacin + metronidazole OR piperacillin-tazobactam
what is the treatment for a patient with unstable/septic cholangitis? (2)
biliary drainage
cholecystectomy when stable
