Biliary Disorders Flashcards
A pt presents with RUQ pain that radiates to the back of his right shoulder, post-prandial pain, and jaundice. What do you suspect and what treatment do you recommend?
Choledocholithiasis/Acute cholecystitis
ERCP for stone removal
MRCP (if in doubt)
Cholecystectomy
A pt presents with jaundice, fever, and RUQ pain. What symptoms is she displaying? What is the most likely underlying etiology?
Charcot’s Triad - Ascending Cholangitis
Choledocholithiasis/complete biliary obstruction w/ bacterial infection
A pt presents with jaundice, fever, RUQ pain, shock, and altered mental status. What symptoms is he displaying? What diagnostic tests should you run?
Reynold’s Pentad - Ascending Cholangitis
CBC, LFT
Blood culture
U/S
A pt presents with Charcot’s triad and altered mental status. What disease do you suspect? How will you treat?
Ascending Cholangitis Urgent ERCP for decompression NPO Admit to ICU Broad-spectrum Abx GI consult
What can cause bile duct obstruction other than gallstones?
Ampullary stricture
Cholangiocarcinoma
Hepatic CA
Ampullary adenomas
A pt presents with fatigue, pruritis, RUQ pain, jaundice, and acute cholangitis. The pt has a Hx of IBD. What do you suspect? How will you diagnose?
Primary Sclerosing Cholangitis
LFTs (elevated AP, transaminases < 300)
Elevated ANA/ASMA
Confirm w/ ERCP
A pt with a Hx of IBD presents with fatigue and pruritis. ERCP shows primary sclerosing cholangitis. How do you treat?
Ursodeoxycholic acid (bear bile0
ERCP - dilate strictures
Tx IBD
Liver transplant (ultimately)
What can cause non-obstructing cholestasis?
Alcoholic liver Dz
NASH
Drug-induced cholestasis: Phenothiazines, OCP, erythromycin
A pt presents with pruritis. While taking her history, you learn she is on OCPs. What do you suspect? How do you diagnose?
Drug-Induced Cholestasis
Cholestasis/hepatitis
Normal imaging (CT, U/S, MRCP)
A middle-aged female presents with fatigue, pruritis, and jaundice. He has a history of thyroid Dz. What disease do you suspect? How will you diagnose?
Primary Biliary Cirrhosis
AMA (95% positive)
Elevated AP & ANA
Liver biopsy & imaging to confirm
A 57 yo female presents complaining of fatigue, pruritis, and jaundice. Her AMA is negative but ANA and AP are elevated. How do you treat?
Primary Biliary Cirrhosis
Ursodeoxycholic acid - follow LFTs Q 3 mo
Cholchicine or MTX
What are some complications associated with primary biliary cirrhosis treatment?
Pruritis, osteoporosis, hyperlipidemia, cirrhosis
