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Biliary Dz Flashcards

1
Q

What is the function of Bile?

A
  1. Digestion and absorption of fats
  2. Excretion of bilirubin
  3. Excretion of cholesterol
  4. Excretion of metabolic by-products
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2
Q

Who is Cholelithiasis MC in?

A
  1. Native Americans
  2. Hispanics
  3. Caucasians
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3
Q

What are the most common type of gallstones?

A

Cholesterol stones

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4
Q

What is the MC presentation of Cholelithiasis?

A

ASX

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5
Q

How will a pt present with cholelithiasis IF they are symptomatic?

A

Biliary colic

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6
Q

US findings in Cholelithiasis

A
  1. Gallstones
  2. Wall thickening
  3. Pericholecystic fluid
  4. “Shadowing”
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7
Q

SYMPOTOMATIC Cholelithiasis treatment

A

Cholelithiasis + Biliary Colic= Cholecystectomy

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8
Q

Define Biliary Colic

A

TEMPORARY obstruction of cystic duct

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9
Q

Biliary Colic etiology

A

Gallstones

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10
Q

Biliary Colic clinical presentation

A

“GB Attack” Following a fatty meal

  1. Dull, constant RUQ pain
  2. +/- Radiation to shoulder
  3. N/V, diaphoresis
  4. Temporary sx’s: 4-6 hrs
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11
Q

Biliary Colic PEx findings

A

Basically Negative:

  1. NO jaundice
  2. Negative Murphy’s sign
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12
Q

Lab findings in Biliary Colic

A

NORMAL

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13
Q

US findings in Biliary Colic

A

Gallstone and/or Sludge causing temporary cystic duct obstruction

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14
Q

Biliary Colic Tx

A

Prophylactic Cholecystectomy

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15
Q

When should you consider Biliary Dyskinesia?

A

In pt’s with typical biliary colic who:

  1. Negative US: NO gallstones or sludge
  2. Normal labs: CBC, LFT’s, amylase, lipase
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16
Q

What is the imaging of choice in suspected Biliary Dyskinesia?

A

HIDA Scan w/ CCK

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17
Q

Who do you NOT give CCK (given with HIDA scan) to?

A

Pt with suspected Gallstones

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18
Q

When is a Cholecystectomy recommended in Biliary Dyskinesia?

A
  1. Typical Biliary sx’s
  2. HIDA scan w/ CCK EF: <35-40%
  3. Ruled out other diagnosis
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19
Q

Define Cholecystitis

A

Acue inflammation of GB d/t sustained obstruction of cystic duct: Cholesterol stones MCly

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20
Q

Acute Cholecystitis si/sx’s

A
  1. Steady, severe RUQ pain
  2. +/- radiation to shoulder/flank
  3. Following fatty meal
  4. N/V, diaphoresis
  5. FEVER
  6. Persistent sx’s: >4-6 hrs
  7. h/o biliary colic
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21
Q

Acute Cholecystitis PEx findings

A
  1. RUQ tenderness
  2. Positive Murphy’s
  3. Fever
  4. Tachycardia
  5. NO jaundice
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22
Q

Acute Cholecystitis complications

A
  1. Gangrene: 20%
  2. Perforation
  3. Generalized peritonitis
  4. Gallstone ileus
  5. Cholecystoenteric fistula
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23
Q

Acute Cholecystitis lab findings

A
  1. Elevated WBC w/ left shift

2. UA: Elevated urobilinogen

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24
Q

What is the INITIAL diagnostic imaging of choice in Acute Cholecystitis?

A

US

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25
Q

US findings in Acute Cholecystitis

A
  1. Gallstones
  2. Wall thickening: >4-5 mm
  3. Pericholecystic fluid
    • Sonographic Murphy’s sign
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26
Q

What imaging is used to CONFIRM the diagnosis of acute cholecystitis?

A

HIDA Scan: Failure of GB to fill in setting of cystic duct obstruction

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27
Q

Acute Cholecystitis management

A
  1. Early Cholecystectom: Recommended in healthy, low risk pt’s (ASA class I and II)
  2. IV Abx (+/-): Ciprofloxacin + Metronidazole
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28
Q

Acute Cholecystitis management in HIGH risk pt’s (ASA III, IV, V)

A
  1. Supportive therapy
  2. Consult Specialist: Surgery, pulmonologist for surgical clearance
  3. Percutaneous cholecystectomy tube for decompression: If medical therapy fails
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29
Q

Who is Acalculous Cholecystitis common in? Prognosis?

A

Critically Ill patients

Worse prognosis

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30
Q

What is Acalculous Cholecystitis associated with?

A
  1. Stasis

2. Ischemia

31
Q

Acalculous Cholecystitis presentation

A
  1. NO gallstones

2. +/- Jaundice

32
Q

Acalculous Cholecystitis treatment

A
  1. Cholecystectomy vs. Cholecystostomy
  2. Blood cultures
  3. Broda spectrum Abx
33
Q

Define Choledocolithiasis

A

Stone in common bile duct (CBD)

34
Q

Choledocolithiasis clinical presentation

A
  1. Asx
  2. RUQ or Epigastric pain
  3. Jaundice: Tea colored urine, light colored stools, pruritus
  4. Hx biliary colic
35
Q

Choledocolithiasis PEx findings in uncomplicated dz

A
  1. Jaundice
  2. Sclereal Icterus
  3. +/- RUQ tenderness
  4. NO peritoneal signs
  5. NO fever
36
Q

Uncomplicated Choledocolithiasis lab findings

A
  1. Elevated conjugated bilirubin

2. Elevated alk. phosph

37
Q

INITIAL imaging of choice in Choledocolithiasis? Findings?

A

US: CBD stone, Dilated CBD, gallstones in GB

38
Q

imaging of choice to CONFIRM Choledocolithiasis

39
Q

What is the preferred therapeutic test in the treatment of Choledocolithiasis?

A

ERCP:

  1. Remove stones
  2. Insert stent
  3. Sphincterectomy
  4. CCY follows
40
Q

Complications of imaging of choice in Choledocolithiasis

A
  1. Cholangitis

2. Pancreatitis

41
Q

Define Ascending Cholangitis

A

ascending INFECTION from duodenum of biliary tract: MCly CBD

associated with CBD stone

42
Q

Ascending Cholangitis acute presentation

A

Charcot’s Triad:

  1. Fever/chills
  2. RUQ pain
  3. Jaundice
43
Q

What is Reynold’s Pentad?

A

Charcots + Hypotension (shock) + AMS

50% mortality rate

44
Q

Lab findings in Ascending Cholangitis

A
  1. Marked Leukocytosis; >20,000
  2. Elevated conjugated bilirubin
  3. Elevated Alk Phos
  4. UA: elated urobilinogen
45
Q

Ascending Cholangitis management

A
  1. ERCP w/ sphincterectomy and stone extraction

2. Follow with CCY

46
Q

Who does Primary Biliary Cirrhosis (PBC) the MC in?

A

Females

Ages 35-60

47
Q

Primary Biliary Cirrhosis etiology

A

Autoimmune destruction of small intrahepatic bile ducts

48
Q

What can Primary Biliary Cirrhosis lead to?

A
  1. Cirrhosis

2. Liver Failure

49
Q

What are the main presenting sx’s in Primary Biliary Cirrhosis?

A
  1. Fatigue

2. Pruritus: BEFORE the jaundice

50
Q

other presenting sx’s in Primary Biliary Cirrhosis?

A
  1. RUQ pain
  2. Hepatomegaly
  3. Arthritis
  4. Skin hyperpigmentation
  5. Xanthomas
  6. CREST sx: Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, Telangiectasias
51
Q

LFT findings in Primary Biliary Cirrhosis?

A

Cholestatic pattern

  1. Elevated Alk phos
  2. Elevated conjugated bilirubin: later in dz
  3. Elevated GGT*
52
Q

What is the hallmark lab finding in Primary Biliary Cirrhosis?

A

+ AMA (Anti-mitochrondrial antibody)

53
Q

What do you need to CONFIRM Primary Biliary Cirrhosis?

54
Q

What is another condition/disorder found in 50% of pt’s with Primary Biliary Cirrhosis?

A

Hyperlipidemia

55
Q

Primary Biliary Cirrhosis management?

56
Q

What do you want to make sure to monitor in Primary Biliary Cirrhosis? Why?

A

Bone density: DEXA d/t increased risk of osteoporosis

57
Q

Who does Primary Sclerosing Cholangitis (PSC) MC in?

58
Q

What condition do over 75% of patients with Primary Sclerosing Cholangitis also have?

A

IBD: Ulcerative Colitis

59
Q

Median survival following Primary Sclerosing Cholangitis dx?

60
Q

Primary Sclerosing Cholangitis Complications

A
  1. Biliary Stricture
  2. Cholangitis
  3. CA: GB, Colon, Cholangiocarcinoma
61
Q

Primary Sclerosing Cholangitis (PSC) clinical presentation?

A
  1. Fatigue
  2. PruritIs AFTER jaundice
  3. Steatorrhea
62
Q

What is the preferred imaging in the diagnosis of Primary Sclerosing Cholangitis (PSC)? Why?

A

ERCP: both diagnostic and therapeutic

63
Q

MRCP findings in Primary Sclerosing Cholangitis (PSC)

A

Multifocal stricturing w/ intrahepatic/extrahepatic ductal dilation

64
Q

Primary Sclerosing Cholangitis Management

A

ERCP: Biliary ductal dilation or stenting

65
Q

What do you want to make sure to monitor in Primary Sclerosing Cholangitis (PSC)? Why?

A

Bone density d/t osteoporosis

66
Q

Define Gilbert Syndrome

A

Deficiency in enzyme for glucuronidation of bilirubin in liver (conjugation)

67
Q

When should you suspect Gilbert Syndrome?

A

UNCONJUGATED hyperbilirubinemia in the ABSENCE of hemolysis= normal CBC, blood smear, reticulocyte count
Normal LFTS

68
Q

What makes up 50% of biliary tract CA?

69
Q

RF’s for GB CA?

A
  1. Cholelithiasis
  2. GB polyps >1 cm
  3. Salmonellla infxn
70
Q

What is the main presenting sx in Cholangiocarcinoma?

71
Q

Lab findings in Cholangiocarcinoma?

A

Cholestatis-Obstructive pattersn

  1. Elevated conjugated bilirubin
  2. Elevated alk phos
  3. Elevated CA 19-9
72
Q

What is Ampulla CA associated with?

A
  1. Familial Adenomatous Polyposis (FAP)

2. Hereditary Non-Polyposis Colon CA (HNPCC)

73
Q

What is the MC presenting sx in Ampulla CA?

A

Obstructive Jaundice

74
Q

Other presenting sx’s in Ampulla CA

A
  1. Occult GIB with microcytic anemia

2. Abdominal pain

Foundations-GI (7 decks)

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