Biliary Tract

Question 1

3 parts of gallbladder

Answer 1

fundus
body
neck

Question 2

Most important part of gallbladder

Answer 2

neck because there is a groove that meets the cystic pouch (Hartmann’s pouch) where stones get stuck

Question 3

common bile duct

Answer 3

cystic duct + hepatic duct

Question 4

Function gallbladder

Answer 4

store bile

bile emulsifies fat- assisting with absorption of fates

Question 5

Patho cholelithiasis

Answer 5

bile–>vesicles–>crystal–>stone

Question 6

Most likely to get cholelithiasis

Answer 6

Native Americans

Question 7

uncomplicated gallbladder disease

Answer 7

biliary colic in the absence of complications such as cholecystitis, cholangitis, or gallstone pancreatitis

Question 8

RF cholelithiasis

Answer 8

Age
women
FHx
Pregnant
Obesity
Rapid weight loss
Diabetes
HyperTG
Medications- OCP, hormone replacement, ceftriaxone
Gallbladder stasis
Decrease physical activity

Question 9

Prevent cholelithiasis

Answer 9

statins
coffee
vegetable protein and nuts
Mediterranean diet- poly/monounsaturated fats
exercise

Question 10

Complications cholelithiasis

Answer 10

acute cholecystits
gallstone pancreatitis
bouvert syndrome (gallstone ileus)

Question 11

Clinical cholelithiasis

Answer 11

asymptomatic
biliary colic RUQ after fatty meal (voluntary guarding)
non-specific abdominal pain
mid epigastric pain
chest pain
full after meal
abdominal distention
N/V
diaphoresis

Question 12

Dx cholelithiasis

Answer 12

CBC with diff
LFT normal- ALT higher than AST if cholestatic pattern
RUQ/abdominal ultrasound

Question 13

Tx cholelithiasis

Answer 13

• Asx/incidental finding= expentant management (signs/sx to look for)
• Sx= prophylactic cholecystectomy

Question 14

Def cholecystitis

Answer 14

inflammation of the gallbladder

Question 15

Acute cholecystitis

Answer 15

RUQ pain, fever, leukocytosis with gallbladder inflammation

Question 16

Acalculous Cholecystitis

Answer 16

identical to acute but without gallstone

Question 17

chronic cholecystitis

Answer 17

recurrent infection or chronic mechanical irritation of galllstones–> fibrosis and thickening of GB

Question 18

Complications fo acute cholecystitis

Answer 18

gangrene of gallbladder
gallbladder perforation–> pericholecystic abscess
emphysematous cholesystitis
mirrizi syndrome- hepatic duct compresses–> jaundice
gallbladder rupture
chronic cholecystitis

Question 19

Sequelae acute cholecystitis

Answer 19

• porcelain gallbladder- discolored brittel consistency due to Ca2+
• strawberry gallbladder- villi enlarged due to cholesterol and look like strawberry
• xanthogranulomatous cholecystitis- macrophage in gladder
• fistulization to the gallbladder
• carcinoma of the gallbladder

Question 20

Clinical acute cholecystitis

Answer 20

• sudden onset RUQ pain/ epigastric after a fatty meal
• N/V
• Murphy sign
• Fever
• Jaundice
• Courvoisier’s sign

Question 21

Dx acute cholecystitis

Answer 21

CBC with diff- leukocytosis with left shift
LFT increased, bilirubin increased is obstruction; ALT higher than AST
RUQ/Abdominal ultrasound

Question 22

Tx acute cholecystitis

Answer 22

Admit to hospital (IVF, pain management, ABX)
cholecystectomy within 24hrs
Pre-op ABX- Cipro and Flagyl, 3rd gen ceph + flagyl, carbapenem

Question 23

Percutaneous drainage indications for acute cholecystitis

Answer 23

pericholecystic abscess
CBD obstruction
significant edema and swelling

Question 24

Def choledocholithiasis

Answer 24

gallstones in the bile duct

Question 25

Complications choledocholithiasis

Answer 25

acute cholangitis acute pancreatitis hyrops gallbladder acute cholecystitis

Question 26

Clinical choledocholithiasis

Answer 26

- biliary type pain - RUQ mid epigastric pain or shoulder pain - afebrile - N/V - jaundice and/or fever if complicated

Question 27

Dx choledocholithiasis

Answer 27

CBC with diff- normal LFT will be cholestatic pattern if stone retained RUQ ultrasound MRCP- no confirmed stone but need to know if have ERCP- confirmed stone that needs out CT with contrast

Question 28

Tx choledocholithiasis

Answer 28

- removal of common bile duct via endoscopically (ERCP) or surgical - most ptn with choledocholithiasis operative repair will have cholecystectomy as well

Question 29

Def acute cholangitis

Answer 29

bacterial infection with biliary obstruction

Question 30

Cause acute cholangitis

Answer 30

biliary calculi benign stenosis malignancy

Question 31

MC organism in acute cholangitis

Answer 31

e.coli

Question 32

Clinical acute cholangitis

Answer 32

``` abdominal pain fever yellow skin wakness charcot triad reynolds pentad ```

Question 33

charcot triad

Answer 33

fever, abdominal pain, jaundice

Question 34

Reynold's pentad

Answer 34

``` fever abdominal pain jaundice confusion hypotension ```

Question 35

Dx acute cholangitis

Answer 35

``` CBC with diff- leukocytosis with left shift LFT- elevated cholestatic pattern Blood culture Abdominal ultrasound first MRCP or ERCP second ```

Question 36

Tx acute cholangitis

Answer 36

admit to hospital empiric ABX- Zosyn, Unasyn, Fluoro + Flagyl, Carbapenem Establish biliary drainage - ERCP- sphincterotomy with stone excision or stent placement

Question 37

Patho Primary Sclerosing Cholangitis

Answer 37

chronic progressive disorder leading to complications of cholestasis and hepatic failure--> multifocal strictures, segmental dilations--> end stage liver disease

Question 38

PSC leads to increased risk of what

Answer 38

cholangiocarcinoma, gallbladder cancer, HCC

Question 39

Who gets PSC

Answer 39

men 20-25

Question 40

Clinical PSC

Answer 40

``` asymptomatic jaundice splenomegaly fatigue pruritis ```

Question 41

DX PSC

Answer 41

LFT with cholestatic pattern | MRCP

Question 42

Tx PSC

Answer 42

liver transplant | symptomatic relief- UDCA, biliary stents