Biliary system Flashcards
If the ultrasound is technically inadequate for diagnosis of cholelithiasis
oral cholecystogram
the best test for confirming acute cystic duct obstruction
HIDA scan
Treatment of cholelithiasis
If the patient has gallstones and is symptomatic, do an elective cholecystectomy because 70% of these patients have recurrent symptoms if not treated. If a patient has gallbladder stones but is asymptomatic, no treatment is indicated
Profile for cholesterol stones
Rapid weight loss in obese patient (prevented by aspirin or ursodeoxycholic acid), American Indian, octreotide use, ileal resection (Crohn disease).
Profile for pigment stones:
Clonorchis (biliary dwelling trematode), sickle cell disease, or anything else that causes hemolysis.
Dx of Acalculous cholecystitis
Diagnosis may be assisted by ultrasound or CT showing no stones, but a large, tense, often thickened gallbladder with pericholecystic fluid (or no stones and a HlDA scan showing cystic duct
obstruction).
treatment of Acalculous cholecystitis
cholecystectomy or cholecystostomy
management of choledocholithiasis
Common duct stones (choledocholithiasis) are removed by ERCP with prn endoscopic sphincterotomy
Charcot’s triad
Acute cholangitis is suggested by the triad of biliary colic. fever and chills, and jaundice
When you suspect suppurative cholangitis, the best procedure for both diagnosis and treatment
ERCP with endoscopic sphincterotomy or surgery if ERCP is not available
Emphysematous cholecystitis management
Emphysematous cholecystitis requires emergent laparotomy with cholecystectomy and antibiotics. In both suppurative cases, the antibiotics must be effective against both Gram negative and anaerobic organisms. Do not use ceftriaxone it can cause biliary concrements!
X-ray showing a gallbladder with a calcified outline
(“porcelain gallbladder”) suggests cancer, and an open cholecystectomy is indicated
symptoms of PBC
The majority of patients present asymptornatically and are worked up because of a high alkaline phosphatase noted on a liver function screening. If they have symptoms, patients initially complain of itching-first in the palms and soles and later throughout the body. They later develop jaundice, hyperpigmentation, vitamin D-dependent osteomalacia, and accelerated osteoporosis
bilirubin and prognosis of PBC
When the bilirubin is>2 .the disease accelerates.Most die soon after the bilirubin
reaches10 unless the patient undergoes liver transplantation.
Whatisthe”hallmark” test for primary biliary cirrhosis? How do you confirm the diagnosis?
The antimitochondrial antibody test is the hallmark test for PBC.
Diagnosis is confirmed only with a liver biopsy, which may show granulomas
