Biliary Disorders

Question 1

biliary cancer prog/RF

Answer 1

• 90% fatal, asx, endoscopic US for WU

- polyps, gallstone dz, congenital biliary cysts, chronic inf, porcelain gallbladder

Question 2

cholangiocarcinoma

Answer 2

• bile ducts
• RF: primary sclerosing cholangitis, choledochal cysts, clonorchis sinensis inf
• Courvoisier’s sign (palpable, nontender gallbladder + jaundice)

Question 3

Gallbladder adenocarcinoma

Answer 3

• 80% of malignancies
• s/s: RUQ pain, wt loss, anorexia, N, obstructive jaundice, ascites
• mgmt: surgical ressection

Question 4

cholelithiasis

Answer 4

• most stones = cholesterol
• S/S: biliary colic (infreq episodes of steady, sev epigastric/RUQ pain w/ rad to R scapula = Boas’ sign)
• RUQ US
• lap chole = TX OF CHOICE (non-surg: lithotripsy, percutaneous stone removal, drain placement)

Question 5

cholecystitis

Answer 5

• stone in cystic duct (can be acalculous, secondary bact inf: Klebsiella, E. coli)
• S/S: sev pain in R hypochondrium/epigastrum, N/V, F, + Murphy’s sign, guarding, rebound tenderness, +/- jaundice
• CBC, liver/pancreatic, US = TEST OF CHOICE, HIDA if acalculous
• lap chole

Question 6

choledocholithiasis

Answer 6

• stone in common bile duct
• S/S of cholecystitis +/-: jaundice, dark urine/light stools, ref shoulder pain not seen often
• labs, endoscopic US or MRCP = TEST OF CHOICE
• TX: endoscopic sphincterotomy (let stone pass thru sphincter of Oddi)

Question 7

Ascending cholangitis

Answer 7

• choledocholithiasis progs to inf (consider in pt w/ h/o biliary dz + recurrent sx), mort = 50%
• Charcot’s triad (F, RUQ pain, jaundice), Reynold’s pentad (Charcot + confusion, hypotension)
• ERCP or abd US (common bile duct dilation)
• Zosyn or ceftriaxone + metronidazole, biliary drainage via ERCP

Question 8

RFs for biliary dz

Answer 8

rapid wt loss, high carb diet, preg, hemolytic anemia, estrogens, TPN, native american, DM, obese, Chron’s, high TG, cirrhosis

Question 9

biliary dz DDX

Answer 9

perf’d PUD, acut pancreatitis, appy (high-lying), perf’d colonic CA, liver abscess, hep, PNA w/ pleurisy

Question 10

biliary dz comps

Answer 10

bile peritonitis, subhepatic abscess, gallstone pancreatitis, pancreatitis s/p endoscopic sphincterotomy