Biliary disorders Flashcards
Cholecystitis is diagnosed with ultrasound or ____
HIDA scan (cholescintigraphy)
What is the recommended management of gallbladder polyps >10mm?
Laparoscopic cholecystectomy
Porcelain gallbladder is treated with ______due to high rates of gallbladder cancer (mostly adenocarcinoma)
prophylactic cholecystectomy
What is the treatment of asymptomatic gallstones?
Lifestyle modifications
Primary sclerosing cholangitis is associated with _____ antibody
p-ANCA
What is the diagnostic test for confirming primary sclerosing cholangitis ?
Magnetic resonance cholangiopancreatography (MRCP)
What demographic is classically affected by primary sclerosing cholangitis (PSC)?
Middle-aged men (classically with IBD)
What is the management for post-cholecystectomy bile leak?
ERCP
Patients who complain of persistent RUQ pain after cholecystectomy should be evaluated for:
Post-cholecystectomy syndrome
What is the treatment for symptomatic choledocholithiasis?
ERCP with sphincterotomy and stone removal; elective cholecystectomy
What is the likely diagnosis in an afebrile child that presents with abdominal pain, jaundice, and a palpable RUQ mass with a normal gallbladder on ultrasound?
Biliary cyst
What is the mnemonic for the risk factors of cholelithiasis again?
Female, Fat, Forty, Fair-skinned, Family history and Fertile
What is the treatment for patients with uncomplicated symptomatic cholelithiasis who are poor surgical candidates long-term (6–24 months) ?
Oral bile acid dissolution therapy with ursodeoxycholic acid (UDCA)
Indications of emergent cholecystectomy:
Gangrenous cholecystitis or gallbladder empyema
When should patients with acute cholecystitis have a cholecystectomy?
Laparoscopic cholecystectomy within 72 hours and after empiric antibiotic therapy
What is the likely diagnosis in a critically ill patient with gallbladder wall thickening / distention and pericholecystic fluid without gallstones on imaging studies?
Acalculous cholecystitis
What is the emergency treatment of choice for acalculous cholecystitis in a critically ill patient?
Antibiotics and percutaneous cholecystostomy
Conditions that result in biliary stasis and/or hypoperfusion of the gallbladder such as trauma, surgery, total parenteral nutrition, multiple transfusions are risk factors for:
Acalculous cholecystitis.
Courvoisier sign:
An enlarged, palpable gallbladder in combination with painless jaundice
What tumors can present with painless jaundice, palpable gallbladder, and weight loss?
- Pancreatic head adenocarcinoma
- Cholangiocarcinoma
- Adenocarcinoma of the ampulla of Vater
