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GK F3 E3 > Biliary Popcorn > Flashcards

Biliary Popcorn Flashcards

1
Q
  • Elevated bilirubin
  • Elevated bilirubin direct
  • Elevated bilirubin indirect
  • ALT & AST are elevated
  • Protime (PT) – ordered w/ INR
  • Labs indicative of liver infection (hepatitis labs)
A

LFT elevation due to Inflammation / Hepatocellular Damage

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2
Q
  • ↑Bilirubin elevated
  • ↑Bilirubin Direct (conjugated)
  • ↑Bilirubin Indirect (unconjugated)
  • ↑Alkaline Phosphatase
  • May see GGT
  • ↓Urine Urobilinogen
A

LFT elevation due to Cholestasis (obstruction such as Choledocholithiasis)

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3
Q
  • ↓Albumin LOW
  • ↓Total Protein LOW
  • ↑PT prolonged/HIGH (ordered w/ INR)
  • ↑INR increased
A

LFT elevation due to Reduced Liver Function

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4
Q

Is urobilinogen normally in the urine?

A

YES

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5
Q

Is Bilirubin normally in the urine?

A

NO

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6
Q

Blood:

  • ↑ bilirubin
  • Normal ALP
  • Normal ALT

Urine:

  • Urobilinogen present +
  • Bilirubin absent -
A

Pre-hepatic

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7
Q

Blood:

  • ↑ bilirubin
  • Normal or ↑ ALP
  • ↑↑↑ ALT

Urine:

  • Urobilinogen: Present (normal)
  • Bilirubin: Present (abnormal)
A

Hepatic

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8
Q

Blood:

  • ↑ bilirubin
  • ↑↑↑ ALP
  • Normal or ↑↑↑ ALP

Urine:

  • Urobilinogen: absent - (abnormal)
  • Bilirubin: present + (abnormal)
A

Post-hepatic

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9
Q

stones in the gallbladder

A

Cholelithiasis

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10
Q

inflammation of the GB

A

Cholecystitis

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11
Q

stones in the CBD

A

Choledocholithiasis

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12
Q

inflammation of the bile ducts

A

Cholangitis

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13
Q

disruption of bile flow…regardless of cause

A

Cholestasis

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14
Q

Which condition?

  • Female, fluffy, forty, fertile
  • Ethnicity: native americans, hispanics, caucasions
  • Cholesterol stones are MC type!!!
  • Initially order an US
A

Cholelithiasis

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15
Q

CCY (cholecystectomy) is recommended in which patient w/ cholelithiasis??

A

Symptomatic! (biliary colic)

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16
Q

Which condition?

  • TEMPORARY obstruction (4-6 hrs)
  • no inflammation
  • “gallbladder attack” after fatty meal
  • “symptomatic biliary disease”
  • Dull RUQ pain
A

Biliary Colic

17
Q

4 conditions where US is intitial test of choice?

A

Cholelithiasis

Biliary Colic

Acute Cholecystitis

Choledocholithiasis (RUQ US)

(BACC)

18
Q

Which condition?

  • Does not appear ill
  • NO jaundice
  • Negative murphy’s sign

Tx?

A

Biliary Colic

Tx: Prophylactic CCY

19
Q

Which condition?

  • Functional GB disorder
  • Motility disorder of GB
  • NO gallstones, so can do HIDA w/ CCK –> EF <35-40%

Tx?

A

Biliary Dyskinesia

  • Tx: CCY if HIDA w/ low EF
  • ***Do not give CCK if pt has gallstones****
20
Q

Which condition?

  • Sustained obstruction of cystic duct
  • Acute inflammation of GB
  • Prior hx of biliary colic
  • SEVERE RUQ pain –> R shoulder/R flank
  • PERSISTENT sxs (>6 hours)
  • ↑ WBC w/ left shift
  • Get US initially, HIDA to confirm

Tx?

A

Acute Cholecystitis

Tx:

  • Admit, analgesics, IV abx (Piper Taco, Cef+Metro, Cipro+Metro)
  • Early CCY
  • Emergency CCY if severe complication (gangrene)
21
Q

Which condition?

  • Gangrene
  • Cholecystoenteric fistula
  • Ill appearing
  • Palpable/Tender GB
  • ++ Murphy’s sign
  • Guarding/Rebound
  • NO jaundice
A

Acute Cholecystitis

22
Q

Tx for Acute Cholecystitis

ASA class 1 or 2

(healthy / low risk pt)

A

Early CCY (on initial hospitalization)

23
Q

Tx for Acute Cholecystitis

ASA class 3, 4, 5

(High risk pt)

A
  • Supportive
  • Consult specialist for surgery clearance
  • Failure of therapy–> percutaneous CCY tube for decompression
24
Q

Which condition?

  • Mechanical irritation from gallstones / repeated acute choleystitis
  • Dx made upon reviewing histology s/p CCY
A

Chronic Cholecystitis

25
Q

Which condition?

  • Critically ill pts
  • Stasis/ischemia
  • Pt hospitalized / worse prognosis
  • Jaundice / No gallstones
  • Secondary infection of GB is COMMON! –> broad abx

Tx?

A

Acalculous Cholecystitis

Tx: Prompt tx w/ CCY or Cholecystostomy

26
Q

Which condition?

  • Blocks flow of bile –> jaundice
  • Hx of biliary colic
  • RUQ/Epi pain
  • Clay stool / Cola urine
  • Jaundice
  • Pruritis
  • RUQ US is intitial test

Tx?

A

Choledocholithiasis

Tx:

  1. Remove stone (ERCP is preferred therapy test)
  2. CCY
  3. Prophylactic abx (piper-taco, Cef+Metro, Cipro+Metro)

GK F3 E3 (24 decks)

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