Biliary System

Question 1

Labs elevated and/or positive w/ PBC (3)

Answer 1

AMA
ALP
IgM

Question 2

PBC treatment

Answer 2

ursodeoxycholic acid 13-15 mg/kg/day

Question 3

PSC MRCP findings

Answer 3

beaded bile ducts (strictures and dilations)

Question 4

PSC biopsy findings

Answer 4

onion-skin fibrosis

Question 5

Imaging/procedural monitoring for PSC (2)

Answer 5

annual MRCP or US
colonoscopy every 1-2 yrs (high UC risk)

Question 6

Pain control for cholelithiasis

Answer 6

ketorolac 30 mg IV

Question 7

Utility of GGT

Answer 7

confirming biliary source of elevated ALP

Question 8

Types of gallstones (2)

Answer 8

cholesterol (most common)
pigment (hemolysis, cirrhosis)

Question 9

Causes of pigmented gallstones (2)

Answer 9

hemolysis
cirrhosis

Question 10

Gold standard diagnosis for cholelithiasis

Answer 10

ultrasound

Question 11

PBC pathophysiology

Answer 11

progressive destruction of intrahepatic ducts - leads to fibrosis and cholestasis

Question 12

Antibody associated w/ PBC

Answer 12

anti-mitochondrial (AMA)

Question 13

Liver enzyme primarily elevated in PBC

Answer 13

alk phos

Question 14

PBC first-line treatment

Answer 14

ursodeoxycholic acid 13-15 mg/kd/day divided into 2 doses

Question 15

Chemotherapy for cholangiocarcinoma (2)

Answer 15

gemcitabine
cisplatin

Question 16

PSC pathophysiology

Answer 16

inflammation and fibrosis of the bile ducts, both intrahepatic AND extrahepatic

Question 17

Timeframe for surgery in acute cholecystitis

Answer 17

72 hours

Question 18

Typical GGT level in cholestasis

Answer 18

elevated

Question 19

Gallbladder polyp size where cholecystectomy is indicated

Answer 19

> 1 cm or symptomatic

Question 20

Causes of GGT elevation (4)

Answer 20

hepatitis
alcohol use disorder
cirrhosis
biliary disease

Question 21

Mutation in Gilbert’s syndrome

Answer 21

UGT1A1 gene

Question 22

Yearly monitoring for PSC (2)

Answer 22

MRCP
CA 19-9