biliary disorders Flashcards
What are possible stone compositions for cholelithiasis?
What are the risk factors for cholelithiasis that don’t fit into the 5 Fs?
- most cholesterol (radiolucent)
- minority are pigmented stones *(calcium bilirubinate- radioopaque due to iron), could also be infectious
- unusual risk factors for cholesterol stones include TPN, recent weight loss, crohn disease
- Alcoholics and those with chronic hemolysis get bilirubin stones
What is the cholecystitis?
acute inflammation of the gallbladder, commonly caused by gallstone obstruction of the CYSTIC DUCT, though acalculous cholecystitis can occur in ppl who are chronically ill or on TPN
How is cholecystitis diagnosed?
history, pts often have increased WBCs; often have incr bilirubin and ALP. US usually shows gallstones. HIDA scan will show cystic duct obstruction
What are complications of cholecystitis?
perforation, gallstone ileus, abscess formation
What triad suggests cholangitis?
RUQ pain, jaundice, and fever
What are the labs that indicate cholangitis?
high AST, ALT, positive blood cultures (key), incr WBC, high bilirubin, increased ALP
if pancreas involved may also have high amylase
What is the tx for cholangitis?
hydration IV abx, endoscopic biliary drainge followed by delayed cholecystectomy. If very sever,e, you must doemergency bile duct decompression
What is primary biliary cirrhosis?
autoimmune disease with intrahepatic bile duct destruction leading to accumulation of cholesterol, bile acids, and bilirubin
What are the risk factors for primary biliary cirrhosis?
RA, sjogren, scleroderma, celiac (autoimmunity)
What is the initial clinical presentation of both PBC and PSC?
fatigue, pruritis, jaundice, xanthomas, hepatosplenomegaly,
What are the key labs in primary biliary cirrhosis, and how is it distinguished from PSC?
primary biliary sclerosis has anti-mitochondrial antibodies
What is the treatment for primary biliary cirrhosis?
ursodeoxycholic acid to help liver function and reduce sx; colchicine or methotrexate for more severe disease, eventual liver transplant
What is primary sclerosing cholangitis?
progressive destruction of intra AND extrahepatic bile ducts that causes fibrosis and cirrhosis
What are the key labs in primary sclerosing cholangitis, and how is it distinguished from primary biliary cirrhosis?
pANCA often positive (and it is associated with UC). On imaging, ERCP shows stricturing and irregularity of extrahepatic and intrahepatic ducts
