Biliary tract@ Flashcards
Anechoic cystic lesion that communicate with biliary tract with which CD cyst?
Type 1 CD cyst
Diverticula of CBDwhich which CD cyst?
Type 2 CD cyst
Intraduodenal and PBJ cyst
Type 3 CD cyst
Both intra and extrahepatic dilation with which CD cyst?
Type 4 CD cyst
Saccular or fusiform dilation without extrahep dilation withwhich CD cyst?
Type 5 CD cyst
What is next step for mgmt once dz PB maljcn?
Cholecystectomy bc 42% risk of CA
Which med protects against gallstones?
Statins after 12-18 months
Name meds that inc gallstones.
Ceftriaxone, fibrates octreotide, estrogen (CEFO)
What percent of pts get gallstones after gastric bypass and what % sxatic?
30% get stones at 6 months; about 10% get sxs from it (1/3)
What is Bouverets syndrome’?
GD obstruction from impacted gallstone
T/F: Tx of Bouverets syndrome includes attempted GS removal and fistula repair.
False, removal only, fistula usu closes on its own
What biliary dz AW AIDS and how to tx?
AIDS related cholangiopathy w papillary stenosis - tx with ERCP and sphincterotomy
What are CCA RFs?
PSC, bile duct cysts, hepatolithiasis, thorotrast toxin, hep viruses, choledocho, DM, smoking
Which parasites AW CCA?
Clonorchis sinensis and opisthorchis viverrini
WHat bug causes typhoid fever?
Salmonella typhi
Who and where is chronic S typhi carriage?
In gallbladder on gallstones - biofilm formation
How to tx chronic S typhi?
Cholecystectomy, no role for abx
T/F: Chronic S typhi inc risk of GB CA.
true
Which factors exlude ampullectomy in adenoma?
Size > 3-4 cm, +LNs, tumor ingrowth/CA, preference for surg
Best mgmt of early stage hilar CCA?
Neoadj chemo, brachytherapy, followed by liver TP
Best tx of CCA in pts who cannot get liver TP or have advanced dz?
Gemcitabine and cisplatin chemotx
Up to what % of pts with CCA wont have high CA 19-9?
10%
New dominant stricture in PSC and polysomy on FISH but neg brushings. What do next?
Repeat ERCP with brushings in 4 months
What is the MC type of GB polyp?
Cholestrol (60%)
CRC risk in UC vs PSC+UC?
combo = 4x higher risk
What is Carolis syndrome?
Carolis dz + cong hepatic fibrosis leading to PoHTN, sponge kidney, cortical cysts, PCKD
What is Carolis dz?
Biliary tree with extensive fusiform and saccular dilations of the intrahepatic ducts
Which PFIC types present as very young child and which as young adult?
Child - 1&2
YA - 3
Which PFIC has elevated GGT?
Type 3 only
ABCB4 gene mut AW what?
PFIC 3
What is initial tx of PFIC?
Urosdiol
What is Rotor syndrome?
AR cause of hyperbili (conj) but no other sxs
UGT1A1 AW what?
Crigler-Najjar
C-N has what type of hyperbili?
Unconj
How to tx C-N I and II?
I - liver TP in early life
II - phenobarbital
RFs for black pigmented GS
hemolysis, cirrhosis, CF, Crohns
RFs for brown pig GS
biliary stasis (stricture/infxn)
RFs for cholesterol GS?
Obesity, female, rapid wt loss
Which is radiopaqu and radiolucent - black and brown pig GS?
Lucent - Brown
Paque - black
Alagilles mutations
JAG1 (95%)
NOTCH2 (5%)
ATP7B
Wilsons dz
UGT1A1
Gilberts/C-N
What is type III CD cyst?
Choledochocele - cystic dilation of intra-duodenal portion of CBD
MC complication of choledochocele?
Pancreatitis
Which type of CD cysts have low MAL potential?
Types II and III
Risk of developing sxs in pts with ascatic gallstones?
20% in 20 yrs
Once pt with GS gets colic, what is likelihood of recurrence?
10-30% at 5 yrs
Risk of complicatiosn after developed bil colic if no surg?
2%/yr
FAP screening for amp CA
start age 25-30, do fd & sd viewer - follow up based on Spiegelman stage - if no abnormalities, repeat in 4 years
What is Oriental cholangiohepatitis?
Recurrent pyogenic cholangitis - will see intrahepatic stones and dilation (Ca bilirubinate stones)
T/F: Adenomyomatosis is considered a premalignant GB polyp
False, non cancerous
How do adenomyomatosis polyps present?
Solitary polyp 1-2 cm in size
What is Carolis syndrome?
Combo of Carolis dz (saccular and fusiform intrahepatic dilation) + cong hepatic fibrosis & PoHTN
What is the quickest that PSC TP pt can re-develop PSC?
3 months, before that think more of HAT
Which pt factors predict nonresponse to UDCA in PBC?
sxs at dx, male gender, younger age at dx
How to distinguish PFIC type III from the rest?
Diagnosed after childhood, elevated GGT, ABCB4 gene mutation, ductular proliferation on bx
Black and brown stones comprised of what? As opposed to MC stones which are Cholesterol.
Calcium bilirubinate
What is the MC complication of choledochocele?
Pancreatitis
What is a choledochocele?
Type III CD cyst
Which CD cysts have low MAL potential?
Type II and III
T/F: Small duct PSC has a better prognosis than large duct.
True
What is the tx of biliary cystadenoma?
Resection due to CA risk with it (20%)
Which organism MC related to AIDS cholangiopathy?
Cryptosporidia
Tx of SOD based on type?
Type 1 - sphincterotomy
Type 2 - mano and if +, sphincterotomy
Type 3 - tx like functional pain bc of high risk of panc following sphincterotomy/ERCP
Rome III criteria for SOD?
Pain lasting > 30 minutes Not better with BM or postural changes Epi or RUQ pain Recurs but not daily pain Alters life or ED visits when gets pain Builds to steady level No other cause of pain
Tx of anastomotic stricture?
Plastic or FCMS every 3 months
With BD leak after chole, which location is most serious and least likely to resolve with stenting?
Main bile duct (type E)
What is best tx for early stage unresectable hilar adenocarcinoma?
Chemo/rads followed by liver TP. Should use 5-FU, Ext beam rads, brachytherapy, iridium-192 beads; maint with capecitabine
