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Clin Med 2 > Biliary Tract > Flashcards

Biliary Tract Flashcards

1
Q

3 parts of gallbladder

A

fundus
body
neck

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2
Q

Most important part of gallbladder

A

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

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3
Q

common bile duct

A

cystic duct + hepatic duct

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4
Q

Function gallbladder

A

store bile

bile emulsifies fat- assisting with absorption of fates

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5
Q

Patho cholelithiasis

A

bile–>vesicles–>crystal–>stone

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6
Q

Most likely to get cholelithiasis

A

Native Americans

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7
Q

uncomplicated gallbladder disease

A

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

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8
Q

RF cholelithiasis

A 
Age
women
FHx
Pregnant
Obesity
Rapid weight loss
Diabetes
HyperTG
Medications- OCP, hormone replacement, ceftriaxone
Gallbladder stasis
Decrease physical activity
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9
Q

Prevent cholelithiasis

A 
statins
coffee
vegetable protein and nuts
Mediterranean diet- poly/monounsaturated fats
exercise
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10
Q

Complications cholelithiasis

A

acute cholecystits
gallstone pancreatitis
bouvert syndrome (gallstone ileus)

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11
Q

Clinical cholelithiasis

A 
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
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12
Q

Dx cholelithiasis

A

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

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13
Q

Tx cholelithiasis

A
  • Asx/incidental finding= expentant management (signs/sx to look for)
  • Sx= prophylactic cholecystectomy
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14
Q

Def cholecystitis

A

inflammation of the gallbladder

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15
Q

Acute cholecystitis

A

RUQ pain, fever, leukocytosis with gallbladder inflammation

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16
Q

Acalculous Cholecystitis

A

identical to acute but without gallstone

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17
Q

chronic cholecystitis

A

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

18
Q

Complications fo acute cholecystitis

A

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

19
Q

Sequelae acute cholecystitis

A
  • 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
20
Q

Clinical acute cholecystitis

A
  • sudden onset RUQ pain/ epigastric after a fatty meal
  • N/V
  • Murphy sign
  • Fever
  • Jaundice
  • Courvoisier’s sign
21
Q

Dx acute cholecystitis

A

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

22
Q

Tx acute cholecystitis

A

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

23
Q

Percutaneous drainage indications for acute cholecystitis

A

pericholecystic abscess
CBD obstruction
significant edema and swelling

24
Q

Def choledocholithiasis

A

gallstones in the bile duct

25
Q

Complications choledocholithiasis

A

acute cholangitis
acute pancreatitis
hyrops gallbladder
acute cholecystitis

26
Q

Clinical choledocholithiasis

A
  • biliary type pain
  • RUQ mid epigastric pain or shoulder pain
  • afebrile
  • N/V
  • jaundice and/or fever if complicated
27
Q

Dx choledocholithiasis

A

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

28
Q

Tx choledocholithiasis

A
  • removal of common bile duct via endoscopically (ERCP) or surgical
  • most ptn with choledocholithiasis operative repair will have cholecystectomy as well
29
Q

Def acute cholangitis

A

bacterial infection with biliary obstruction

30
Q

Cause acute cholangitis

A

biliary calculi
benign stenosis
malignancy

31
Q

MC organism in acute cholangitis

A

e.coli

32
Q

Clinical acute cholangitis

A 
abdominal pain
fever
yellow skin
wakness
charcot triad
reynolds pentad
33
Q

charcot triad

A

fever, abdominal pain, jaundice

34
Q

Reynold’s pentad

A 
fever
abdominal pain
jaundice
confusion
hypotension
35
Q

Dx acute cholangitis

A 
CBC with diff- leukocytosis with left shift
LFT- elevated cholestatic pattern
Blood culture
Abdominal ultrasound first 
MRCP or ERCP second
36
Q

Tx acute cholangitis

A

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

37
Q

Patho Primary Sclerosing Cholangitis

A

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

38
Q

PSC leads to increased risk of what

A

cholangiocarcinoma, gallbladder cancer, HCC

39
Q

Who gets PSC

A

men 20-25

40
Q

Clinical PSC

A 
asymptomatic
jaundice
splenomegaly
fatigue
pruritis
41
Q

DX PSC

A

LFT with cholestatic pattern

MRCP

42
Q

Tx PSC

A

liver transplant

symptomatic relief- UDCA, biliary stents

Clin Med 2 (25 decks)

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