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GI - 2 > Biliary Gallbladder > Flashcards

Biliary Gallbladder Flashcards

1
Q

Cholelithiasis

A

Gallstones

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2
Q

2 types of gallstones?

A
  1. Cholesterol

2. Pigment stones (calcium)

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3
Q

Symptoms of Cholelithiasis?

A
  • Starts as Asymptomatic
  • Stones trigger inflammation or cause obstruction*
    = Biliary Colic, Right scapula/back pain and N/V
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4
Q

What is Biliary Colic?

A

RUQ steady ache especially 30-90 minutes after meals

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5
Q

Symptoms of Cholelithiasis?

A
  • Starts as Asymptomatic
  • Stones trigger inflammation or cause obstruction*
    = Biliary colic, Right scapula/back pain and N/V
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6
Q

With Cholelithiasis the laboratory findings are normal. What test should you do and what will it show?

A

RUQ US

= Stones with acoustic shadowing

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7
Q

Risk factors for Cholelithiasis?

A

Female, Fertile, Fat, 40, Fair, Family history

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8
Q

Protective factors against Cholelithiasis?

A

Low carbs, High fiber
Physical activity
Coffee and NSAIDs and Statin therapy

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9
Q

Cholecystitis

A

Gallbladder inflammation

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10
Q

2 common causes of Acute Cholecystitis?

A
  1. Calculous (stones) in cystic duct

2. Acalculous (no stones) = illness/infections

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11
Q

Symptoms of Acute Cholecystitis?

A

Fatty meal causes attack:

= Pain in RUQ/epigastrum, fever, N/V

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12
Q

Symptoms of Acute Cholecystitis?

A

Fatty meal causes attack:

= Pain in RUQ/epigastrum, fever, N/V

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13
Q

What are the (+) signs of Acute Cholecystitis?

A

(+) murphy sign

(+) dark colored urine and acholic stools

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14
Q

Tea colored dark urine and acholic stools are seen with?

A

Acute Cholecystitis

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15
Q

What will the RUQ US show with Acute Cholecysitits?

A

GB wall thickening, pericholecystic fluid, stones and acoustic shadow

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16
Q

What will the RUQ US show with Acute Cholecystitis?

A

GB wall thickening, pericholecystic fluid, stones and acoustic shadow

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17
Q

Treatment for Acute Cholecystitis?

A

Surgery and antibiotics

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18
Q

2 possible complications of Acute Cholecystitis?

A
  1. GB gangrene

2. Emphysematous Cholecystitis

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19
Q

2 possible complications of Acute Cholecysitits?

A
  1. GB gangrene

2. Emphysematous Cholecystitis

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20
Q

What is the order of events if gangrene of the gallbladder occurs?

A
  • Perforation
  • Abscess
  • Peritonitis
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21
Q

What is a huge risk factor for developing emphysematous cholecystitis?

A

UNCONTROLLED diabetes mellitus

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22
Q

What is emphysematous cholecystitis and what causes it?

A

Gas in the wall of the gallbladder

– due to uncontrolled diabetes or acute cholecystitis

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23
Q

Treatment for emphysematous cholecystitis?

A

Urgent Cholecystectomy

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24
Q

What causes Chronic Cholecystitis?

A

Repeated cholecystitis due to gallstones

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25
Q

Symptoms of Chronic Cholecystitis?

A
  • Asymptomatic

- - Intermittent, post-prandial RUQ pain and dyspepsia

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26
Q

Symptoms of Chronic Cholecystitis?

A
  • Asymptomatic

- - Intermittent, post-prandial RUQ pain and dyspepsia

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27
Q

What will RUQ US show with Chronic Cholecystitis?

A

Gallstones and contracted gallbladder

28
Q

Contracted gallbladder is seen with?

A

Chronic Cholecystitis

29
Q

Possible complication of Chronic Cholecystitis?

A

Porcelain GB

30
Q

Porcelain Gallbladder

A
  • possible complication of Chronic Cholecystitis

= Calcified Gallbladder

31
Q

Porcelain gallbladder increases your risk for?

A

Gallbladder cancer

32
Q

Choledocholithiasis

A

Gallstones in common bile duct

33
Q

Symptoms of Choledocholithiasis?

A

Severe RUQ pain, fever, jaundice

34
Q

Symptoms of Choledocholithiasis?

A

Severe RUQ pain, fever, jaundice

35
Q

What labs will be elevated with Choledocholithiasis?

A

Liver enzymes and possibly lipase/amylase due to secondary pancreatitis

36
Q

What test should be done if Choledocholithiasis is suspected?

A

ERCP with sphincterotomy and stone extraction/stent placement

37
Q

What test should be done if Choledocholithiasis is suspected?

A

ERCP with sphincterotomy and stone extraction/stent placement

38
Q

Possible complications of Choledocholithiasis?

A

Acute pancreatitis

Ascending Cholangitis

39
Q

What may cause Ascending Cholangitis?

A

Choledocholithiasis

40
Q

What is Ascending Cholangitis?

A

Obstruction in common bile duct causes infection of the biliary tract

41
Q

Possible symptoms with Ascending Cholangitis?

A
  • Charcot triad: RUQ pain, fever, jaundice

- Reynold pentad: charcot triad, hypotension, altered mental status

42
Q

Possible symptoms with Ascending Cholangitis?

A
  • Charcot triad: RUQ pain, fever, jaundice

- Reynold pentad: charcot triad, hypotension, altered mental status

43
Q

With Ascending Cholangitis, what will the lab tests show?

A 
Leukocytosis
Blood cultures (+)
44
Q

What test should be done with Ascending Cholangitis?

A

ERCP with sphincterotomy and stone extraction/stent placement

45
Q

Possible complication of Ascending Cholangitis?

A

Acute pancreatitis

46
Q

What is Biliary Dyskinesia?

A

Functional disorder of gallbladder

47
Q

Symptoms of Biliary Dyskinesia?

A

Frustrated patient with biliary colic

48
Q

With Biliary Dyskinesia, all tests come back NORMAL. What test should you do?

A

HIDA scan with CCK

49
Q

With Biliary Dyskinesia, what will the HIDA scan with CCK show?

A

Abnormal ejection fraction (less than 35-38%)

50
Q

Primary Sclerosing Cholangitis is often associated with?

A

Males with IBD – Ulcerative colitis

51
Q

Primary Sclerosing Cholangitis is often associated with?

A

Males with IBD – Ulcerative colitis

52
Q

Symptoms of Primary Sclerosing Cholangitis?

A

RUQ pain, jaundice, pruritus

53
Q

Symptoms of Primary Sclerosing Cholangitis?

A

RUQ pain, jaundice, pruritus

54
Q

What is elevated with Primary Sclerosing Cholangitis?

A

Alkaline Phosphatase and bilirubin

55
Q

What will the MRCP/ERCP show with Primary Sclerosing Cholangitis?

A

“beads on a string”

= segmental fibrosis of bile ducts with dilations between them

56
Q

“beads on a string” with ERCP?

A

Primary Sclerosing Cholangitis

57
Q

What will the liver biopsy show with Primary Sclerosing Cholangitis?

A

Onion skinning

58
Q

Primary Sclerosing Cholangitis puts you at increased risk for?

A

Increased risk for cholangiocarcinoma, colon cancer and ascending cholangitis

59
Q

Is there proven therapy for Primary Sclerosing Cholangitis?

A

NO

60
Q

What is Primary Biliary Cholangitis?

A

Autoimmune destruction of small intrahepatic bile ducts and cholestasis

61
Q

What is Primary Biliary Cholangitis?

A

Autoimmune destruction of small intrahepatic bile ducts and cholestasis

62
Q

What increases your risk of Primary Biliary Cholangitis?

A

Female, UTIs, Hormone therapy, smoking and hair dye use

63
Q

What will the lab results show with Primary Biliary Cholangitis?

A

ISOLATED elevated Alkaline Phosphatase
(increased GGT)
Antimitochondrial antibodies

64
Q

What will the lab results show with Primary Biliary Cholangitis?

A

ISOLATED elevated Alkaline Phosphatase
(increased GGT)
Antimitochondrial antibodies

65
Q

Symptoms of Primary Biliary Cholangitis?

A

Jaundice, pruritus, xanthelasma

66
Q

Symptoms of Primary Biliary Cholangitis?

A

Jaundice, Pruritus, xanthelasma

GI - 2 (61 decks)

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