biliary tract

Question 1

concentric fibrosis of bile ducts

Answer 1

primary sclerosing cholangitis

Question 2

“beads on string” on ERCP

Answer 2

primary sclerosing cholangitis: irregular areas of stricturing + dilation of biliary tract on ERCP

Question 3

40 yo male
\+ p-ANCA (80%)
associated with:
ulcerative colitis
cholangiocarcinioma

Answer 3

primary sclerosing cholangitis

Question 4

autoimmune disease
T cells attack bile ductules within liver parenchyma → lymphocytic infiltrate in liver, granulomas may be present → over time: cirrhosis (liver failure, portal HTN, HCC)

Answer 4

primary biliary cirrhosis

Question 5

50 yo female
\+ antimitochondrial antibody (+ AMA)
associated with:
sjogren syndrome 
CREST scleroderma
RA

Answer 5

primary biliary cirrhosis

Question 6

treatment of primary biliary cirrhosis

Answer 6

ursadiol (ursodeoxycholic acid)

Question 7

definitive treatment for primary biliary cirrhosis or primary sclerosing cholangitis

Answer 7

liver transplant

Question 8

cirrhosis from biliary obstruction secondary to extrahepatic process blocking hepatic biliary flow: gallstones, biliary stricture, chronic pancreatitis, head pancreatic cancer → back up of pressure into intrahepatic ducts → bile stasis, fibrosis, cirrhosis

Answer 8

secondary biliary cirrhosis

Question 9

presentation of primary biliary cirrhosis or primary sclerosing cholangitis or
secondary biliary cirrhosis

Answer 9

jaundice (bilirubin in skin)
pruritis
dark urine
light colored stools (acholic) stools (bilirubin not making it into stool to be converted to urobilogen)
↑ alk phos (due to cholestasis - stasis of bile)
↑ direct bilirubin

Question 10

risk factor for cholesterol cholelithiasis (gallstone)

Answer 10

Fat
Fertile = ↑ risk with pregnancy, oral OCPs
Female
> Forty

Question 11

types of gallstones

Answer 11

cholesterol stones
pigment stones: bilirubin
mixed stones: cholesterol + pigment

Question 12

complication of gallstone

Answer 12

pnuemobilia: fistula between gallbladder and small intestine → are in biliary tree
gallstone ileus: gallstone obstructs ileocecal valve

Question 13

diagnosis of gallstones (cholelithiasis)

Answer 13

RUQ US (white = stone)
HIDA scan: inject radiolabeled HIDA → excreted in bile by hepatocytes (if can't see GB = obstruction of cystic duct)

Question 14

RUQ pain due to gallbladder contractions AFTER eating (due to CCK)

Answer 14

biliary colic pain: contractions force stone in cystic duct

Question 15

Charcot triad:
jaundice
fever
RUQ pain 
or Reynold's pentad
jaundice
fever
RUQ pain 
hypotension
AMS

Answer 15

Charcot triad of cholangitis

Question 16

+ murphy sign: hand under rib cage → inhale deeply (hurts so cut breath short)

Answer 16

cholecystitis

Question 17

causes of cholecystitis

Answer 17

gallstones
ischemia
CMV

Question 18

"liver fluke"
infects biliary tree → inflammation of biliary tree 
associated with:
pigmented gallstones
cholangiocarcinoma

Answer 18

clonorchis sinesis