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Biliary tract@ Flashcards

1
Q

Anechoic cystic lesion that communicate with biliary tract with which CD cyst?

A

Type 1 CD cyst

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2
Q

Diverticula of CBDwhich which CD cyst?

A

Type 2 CD cyst

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3
Q

Intraduodenal and PBJ cyst

A

Type 3 CD cyst

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4
Q

Both intra and extrahepatic dilation with which CD cyst?

A

Type 4 CD cyst

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5
Q

Saccular or fusiform dilation without extrahep dilation withwhich CD cyst?

A

Type 5 CD cyst

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6
Q

What is next step for mgmt once dz PB maljcn?

A

Cholecystectomy bc 42% risk of CA

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7
Q

Which med protects against gallstones?

A

Statins after 12-18 months

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8
Q

Name meds that inc gallstones.

A

Ceftriaxone, fibrates octreotide, estrogen (CEFO)

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9
Q

What percent of pts get gallstones after gastric bypass and what % sxatic?

A

30% get stones at 6 months; about 10% get sxs from it (1/3)

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10
Q

What is Bouverets syndrome’?

A

GD obstruction from impacted gallstone

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11
Q

T/F: Tx of Bouverets syndrome includes attempted GS removal and fistula repair.

A

False, removal only, fistula usu closes on its own

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12
Q

What biliary dz AW AIDS and how to tx?

A

AIDS related cholangiopathy w papillary stenosis - tx with ERCP and sphincterotomy

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13
Q

What are CCA RFs?

A

PSC, bile duct cysts, hepatolithiasis, thorotrast toxin, hep viruses, choledocho, DM, smoking

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14
Q

Which parasites AW CCA?

A

Clonorchis sinensis and opisthorchis viverrini

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15
Q

WHat bug causes typhoid fever?

A

Salmonella typhi

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16
Q

Who and where is chronic S typhi carriage?

A

In gallbladder on gallstones - biofilm formation

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17
Q

How to tx chronic S typhi?

A

Cholecystectomy, no role for abx

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18
Q

T/F: Chronic S typhi inc risk of GB CA.

A

true

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19
Q

Which factors exlude ampullectomy in adenoma?

A

Size > 3-4 cm, +LNs, tumor ingrowth/CA, preference for surg

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20
Q

Best mgmt of early stage hilar CCA?

A

Neoadj chemo, brachytherapy, followed by liver TP

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21
Q

Best tx of CCA in pts who cannot get liver TP or have advanced dz?

A

Gemcitabine and cisplatin chemotx

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22
Q

Up to what % of pts with CCA wont have high CA 19-9?

A

10%

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23
Q

New dominant stricture in PSC and polysomy on FISH but neg brushings. What do next?

A

Repeat ERCP with brushings in 4 months

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24
Q

What is the MC type of GB polyp?

A

Cholestrol (60%)

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25
CRC risk in UC vs PSC+UC?
combo = 4x higher risk
26
What is Carolis syndrome?
Carolis dz + cong hepatic fibrosis leading to PoHTN, sponge kidney, cortical cysts, PCKD
27
What is Carolis dz?
Biliary tree with extensive fusiform and saccular dilations of the intrahepatic ducts
28
Which PFIC types present as very young child and which as young adult?
Child - 1&2 | YA - 3
29
Which PFIC has elevated GGT?
Type 3 only
30
ABCB4 gene mut AW what?
PFIC 3
31
What is initial tx of PFIC?
Urosdiol
32
What is Rotor syndrome?
AR cause of hyperbili (conj) but no other sxs
33
UGT1A1 AW what?
Crigler-Najjar
34
C-N has what type of hyperbili?
Unconj
35
How to tx C-N I and II?
I - liver TP in early life | II - phenobarbital
36
RFs for black pigmented GS
hemolysis, cirrhosis, CF, Crohns
37
RFs for brown pig GS
biliary stasis (stricture/infxn)
38
RFs for cholesterol GS?
Obesity, female, rapid wt loss
39
Which is radiopaqu and radiolucent - black and brown pig GS?
Lucent - Brown | Paque - black
40
Alagilles mutations
JAG1 (95%) | NOTCH2 (5%)
41
ATP7B
Wilsons dz
42
UGT1A1
Gilberts/C-N
43
What is type III CD cyst?
Choledochocele - cystic dilation of intra-duodenal portion of CBD
44
MC complication of choledochocele?
Pancreatitis
45
Which type of CD cysts have low MAL potential?
Types II and III
46
Risk of developing sxs in pts with ascatic gallstones?
20% in 20 yrs
47
Once pt with GS gets colic, what is likelihood of recurrence?
10-30% at 5 yrs
48
Risk of complicatiosn after developed bil colic if no surg?
2%/yr
49
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
50
What is Oriental cholangiohepatitis?
Recurrent pyogenic cholangitis - will see intrahepatic stones and dilation (Ca bilirubinate stones)
51
T/F: Adenomyomatosis is considered a premalignant GB polyp
False, non cancerous
52
How do adenomyomatosis polyps present?
Solitary polyp 1-2 cm in size
53
What is Carolis syndrome?
Combo of Carolis dz (saccular and fusiform intrahepatic dilation) + cong hepatic fibrosis & PoHTN
54
What is the quickest that PSC TP pt can re-develop PSC?
3 months, before that think more of HAT
55
Which pt factors predict nonresponse to UDCA in PBC?
sxs at dx, male gender, younger age at dx
56
How to distinguish PFIC type III from the rest?
Diagnosed after childhood, elevated GGT, ABCB4 gene mutation, ductular proliferation on bx
57
Black and brown stones comprised of what? As opposed to MC stones which are Cholesterol.
Calcium bilirubinate
58
What is the MC complication of choledochocele?
Pancreatitis
59
What is a choledochocele?
Type III CD cyst
60
Which CD cysts have low MAL potential?
Type II and III
61
T/F: Small duct PSC has a better prognosis than large duct.
True
62
What is the tx of biliary cystadenoma?
Resection due to CA risk with it (20%)
63
Which organism MC related to AIDS cholangiopathy?
Cryptosporidia
64
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
65
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 ```
66
Tx of anastomotic stricture?
Plastic or FCMS every 3 months
67
With BD leak after chole, which location is most serious and least likely to resolve with stenting?
Main bile duct (type E)
68
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

Gastro Review (15 decks)

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