Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Biliary Tract Disease > Flashcards

Biliary Tract Disease Flashcards

1
Q

What demographics have a high rate of cholesterol gallstones?

A

Mexican Americans and several American Indian tribes, particularly the Pima Indians in the Southwest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for biliary tract disease?

A 
Women affected 3x more than men
Prevalence increases with age
Clusters in families
Obesity 
Multi-parity 
High-dose estrogen OCPs
Rapid weight loss
Prolonged TPN
Pregnancy is thought to predispose one to gallstones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Between meals, sphincter of Oddi contracts and diverts bile into:

A

Gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What stimulates contraction of the gallbladder and relaxation of the sphincter of Oddi in response to fats in duodenum?

A

Cholecystokinin (CCK)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is bile composed of?

A

cholesterol, bile salts, and phospholipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common type of gallstone?

A

Mixed stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a mixed stone?

A

High proportion of cholesterol with bile acids and lecethin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the types of gallstones?

A 
Mixed
Cholesterol
Black
Brown 
(Sludge)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are black stones indicative of?

A

Hemolytic disease and cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are brown stones and where are they usually found?

A

Infected bile

Usually present in the CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where do most Choledocholethiasis come from?

A

Gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are primary common bile duct stones?

A

Formed in the CBD itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are primary CBD stones usually from?

A

Stasis or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which imaging is the standard of care for gallstones?

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the recommended treatment for asymptomatic gallstones for both diabetics and non-diabetics?

A

Observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cirrhosis leads to an increased incidence of what?

A

Gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the recommended treatment for a patient with asymptomatic gallstones in a pt with cirrhosis?

A

Careful observation

Early intervention for Child’s A & B when symptoms develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the recommended treatment for a pt with hemolytic anemia and asymptomatic gallstones?

A

Cholecystectomy at time of splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the recommended treatment for a pt with Somatostatinoma and asymptomatic gallstones?

A

Cholecystectomy recommended at time of tumor resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the recommended treatment for a pt undergoing bariatric surgury and asymptomatic gallstones?

A

Likely to develop symptoms in post op period

Adding cholecystectomy to procedure adds minimal M & M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the recommended treatment for a pt with porcelain gallbladder and asymptomatic gallstones?

A

Cholecystectomy

Porcelain gallbladder associated with 20-60% cancer risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is biliary colic caused by?

A

a stone that lodges in the cystic duct causing an obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why do symptoms resolve with biliary colic?

A

The stone does not stay lodged and when it becomes un-lodged, the symptoms resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What cause pain in biliary colic?

A

distention of the gallbladder, not inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where is the pain located with biliary colic?

A

RUQ, less likely epigastric. May go to back. May radiate to right shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the characteristics of pain with biliary colic?

A

Visceral - dull, aching
Severe
Increases in severity, plateaus for several hours, then decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What symptoms are associated with biliary colic?

A

N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the duration of pain with biliary colic?

A

1 – 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are precipitating factors of biliary colic?

A

Large fatty meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are alleviating factors of biliary colic?

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What will the abdominal exam show with biliary colic?

A

Soft, ND +/- tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What will be on labs with biliary colic?

A

CBC w/diff – nl

LFTs - nl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What will the ultrasound show with biliary colic?

A

gallstones w/o GB wall thickening or pericholocystic fluid and nl CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the recommended treatment for biliary colic?

A

Elective cholecystectomy

Less complications, shorter hospital stay if operation done electively rather than at time of acute cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should gallbladder dyskinesia be suspected?

A

In pts with sx suggestive of biliary colic but no stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What imaging is used for gallbladder dyskinesia?

A

Nuclear cholescintigraphy (HIDA, PPIDA, radionuclide biliary scan) with CCK stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a normal gallbladder ejection fraction?

A

Normal > 35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What causes acute cholecystitis?

A

Persistent stone impaction in the cystic duct causes the gallbladder to become distended and progressively inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does acute cholecystitis present?

A

pain of biliary colic that persists and worsens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What have most acute cholecystitis patients experienced in the past?

A

Biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Where is the pain located with acute cholecystitis?

A

RUQ or epigastric. May go to back. May radiate to right shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the characteristics of pain with acute cholecystitis?

A

Sharp and better localized. Constant and severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the associated sx of acute cholecystitis?

A

N/V, fever, chills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the duration of pain in acute cholecystitis?

A

3 – 4 hours to several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the precipitating factors of acute cholecystitis?

A

Large fatty meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the alleviating factors of acute cholecystitis?

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What vital signs are associated with acute cholecystitis?

A

+/- fever, +/- tachycardia, +/- hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What will the abdominal exam show with acute cholecystitis?

A

Soft, tender in RUQ
May have localized guarding or rebound
+ Murphey’s sign
Mass RUQ in 20% - tender!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What will labs show for acute cholecystitis?

A

CBC w/diff - +/- leukocytosis with left shift

LFTs – Most likely normal. You can have mild elevation of AST (< 1.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What will US show for acute cholecystitis?

A 
US - gallstones w/ distended GB 
GB wall thickening
pericholocystic fluid 
US Murphy’s sign  
Nl CBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the tx for acute cholecystitis?

A 
NPO
IVF
IV ABX
IV pain meds
Anti-emetics
Early cholecystectomy (within a few days of symptom onset)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What bacteria is seen with acute cholecystitis?

A

E. coli, K. pneumonia, S. faecalis

Gram – aerobes and enterococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the ddx with acute cholecystitis?

A

Acute hepatitis
Acute pancreatitis
Perforated peptic ulcer
Acute appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Acalculous cholecystitis is seen in what demographic?

A

Usually in a patient who is acutely ill for other reasons

Common in ICU patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What will US show for acalculus cholecystitis?

A

no stones but other findings of acute cholecystitis

56
Q

What imaging besides US should be ordered for acalculus cholecystitis?

A

Nuclear cholescintigraphy (HIDA, PPIDA, radionuclide biliary scan)

57
Q

What is the tx for acalculuous cholecystitis?

A

Cholecystectomy or cholecystectomy tube

58
Q

What is an empyema?

A

Bacterial proliferation in the obstructed GB

59
Q

What signs and sx are seen with an empyema?

A

Marked fever and leukocytosis

60
Q

What is the tx for an empyema?

A

Early decompression

61
Q

What are the sx of gallbladder perforation?

A

High fever, chills, rigors, septic shock

62
Q

What causes an Emphysematous cholecystitis?

A

Gas-forming organism

63
Q

What does an Emphysematous cholecystitis have a higher risk of?

A

Gangrene

64
Q

What condition predisposes a pt to have Emphysematous cholecystitis?

A

DM

65
Q

What is the treatment for Emphysematous cholecystitis?

A

Emergency cholecystectomy after stabilization

66
Q

What is Hydrops (mucocele) of the gallbladder?

A

Over-distended gallbladder with mucoid or clear and watery content
From gallstone disease
Non-inflammatory
From gallstone disease

67
Q

How does Hydrops (mucocele) of the gallbladder present?

A

Presents similar to biliary colic but sx last longer and palpable minimally tender GB - sometimes to pelvis

68
Q

What is the gold standard cholecystectomy surgery?

A

Laperoscopic cholecystectomy

69
Q

What are the risks of laperoscopic cholecystectomy?

A 
Adhesions 
poor visualization of critical structures 
hemorrhage
bile duct injury
injury to another organ
70
Q

What is the positioning of the patient and surgeons for Laperoscopic cholecystectomy?

A

pt supine with arms out

Surgeon on the left, assistant on the right

71
Q

What are intraoperative cholangiograms used for?

A

Identify CBD stones and delineate biliary anatomy

Occult CBD stones exist in 4-10% of pts

72
Q

What is the triangle of Calot?

A

Usual location of the cystic artery

73
Q

What structures form the triangle of Calot?

A

Common hepatic duct, cystic duct, edge of liver

74
Q

What are the complications of a lap chole?

A 
CBD injury – rare, serious complication
Bowel injury
Bleeding
Infection
Bile leak
75
Q

What is the duct of Luschka?

A

tiny ducts that drain from the liver into the body of the GB, can cause bile leak

76
Q

What are the two structures that could leak bile?

A

Duct of Luschka

Cystic duct stump

77
Q

How is a bile leak evaluated?

A

Labs and PIPIDA scan +/- other imaging to look for fluid collection

78
Q

How is a bile leak treated?

A

Percutaneous drainage or ERCP stent placement or combination or surgical drain placement

79
Q

What is the post-cholecystectomy syndrome?

A

Epigastric or RUQ pain after cholecystectomy
40% of patients have minor GI complaints
Gas, bloating, abdominal pain, or diarrhea

80
Q

What is most often the cause of persistent post-cholecystectomy syndrome?

A

Wrong preoperative dx

81
Q

What causes choledocholethiasis?

A

Common bile duct stones

82
Q

Where do most stones originate in choledocholethiasis?

A

GB and migrate to CBD

83
Q

What physical sign is consistent with choledocholethiasis?

A

Intermittent jaundice

84
Q

What can choledocholethiasis progress to?

A

Cholangitis (inflammation of bile ducts)

85
Q

What other signs/sx are associated with the jaundice caused by choledocholethiasis?

A

Puritis, clay colored stools, tea colored urine

86
Q

What is the location of pain with choledocholethiasis?

A

RUQ. Could be intermittent. Could have no pain at all

87
Q

What will vitals show for a pt with choledocholethiasis?

A

Normal

88
Q

What will the abdominal exam show for a pt with choledocholethiasis?

A

Soft NTND. May be tender

89
Q

What will labs show for choledocholethiasis?

A

CBC w/diff – usually normal
LFTs - elevated T. bili, mostly direct, marked elevation of alk phos and GGT. Mild elevation of AST and ALT.
Amylase and lipase - normal

90
Q

What will US show for choledocholethiasis?

A

US - gallstones +/- CBD stone. Dilated intra- and extra- hepatic ducts. Dilated CBD >6-8mm.

91
Q

What test other than US should be ordered for choledocholethiasis?

A

Cholangiography (MRCP or ERCP or IOC)

92
Q

What are the advantages/disadvantages of MRCP?

A

less invasive. Can’t be therapeutic

93
Q

What are the advantages/disadvantages of ERCP?

A

Invasive, but can be therapeutic

94
Q

What is the ultimate treatment for CBD stones?

A

Lap chole prevents future CBD stones

95
Q

How are cbd stones treated if they pass on their own?

A

Wait to pass then do lap chole

96
Q

How are CBD stones treated if they will not pass?

A

ERCP with sphinterotomy and stone extraction

97
Q

What is an alternative to ERCP for finding a CBD stone?

A

Surgical CBD exploration laparoscopically

98
Q

What is acute ascending cholangitis?

A

Septic process of the biliary tree

Combination of inflammation from bacteria in the bile and some degree of biliary obstruction

99
Q

What is the most common cause of acute ascending cholangitis?

A

CBD stones or benign strictures

100
Q

What are some other causes of acute ascending cholangitis?

A 
malignancy 
internal biliary stents
pancreatitis
Mirizzi’s syndrome
viral infection
parasitic infection
duodenal ulcer
101
Q

What is the ddx for acute ascending cholangitis?

A

Acute hepatitis
Acute pancreatitis
Perforated peptic ulcer
Acute appendicitis

102
Q

Where is the location of pain for acute ascending cholangitis?

A

RUQ or epigastric. May go to back. May radiate to right shoulder

103
Q

What are the characteristics of the pain for acute ascending cholangitis?

A

Visceral - dull, aching. Steady and severe

104
Q

What are the associated sx with acute ascending cholangitis?

A

N/V/F/C, yellowing of the eyes and skin, clay colored stools and tea colored urine

105
Q

What will general survey show for acute ascending cholangitis?

A

Uncomfortable, juandice, may have confusion, may be diaphoretic and appear very ill (septic)

106
Q

What will vitals show for acute ascending cholangitis?

A

Fever, tachycardia, hypotension if suppurative

107
Q

What will the abdominal exam show for acute ascending cholangitis?

A

RUQ tenderness, may have localized guarding and rebound

108
Q

What will labs show for acute ascending cholangitis?

A

CBC w/diff - leukocytosis with left shift
LFTs - elevated T. bili, mostly direct, marked elevation of alk phos and GGT. Mild elevation of AST and ALT
Amylase and lipase - normal

109
Q

What will US show for acute ascending cholangitis?

A

US - gallstones +/- CBD stone. Dilated intra- and extra- hepatic ducts. Dilated CBD >6-8mm

110
Q

What is Charcot’s Triad for acute ascending cholangitis?

A

Fever
Jaundice
RUQ pain

Occurs in only 20% of pts

111
Q

What is Reynold’s Pentad for acute SUPPURATIVE cholangitis?

A

Charcot’s triad +
Mental status changes (Delirium)
Hypotension (Shock)

112
Q

What is the tx for acute ascending cholangitis?

A 
NPO
IVFs 
Broad-spectrum antibiotics
Biliary decompression
Drainage can be endoscopic – ERCP (GI) or percutaneous transhepatic  - PTC (radiologist)
113
Q

What is the tx for acute ascending cholangitis if the cause is due to stones?

A

Lap chole

114
Q

What is a gallstone ileus?

A

When a large gallstone (2 cm) causes a SBO by lodging in the distal ileus

115
Q

How does a gallstone get into the small bowel?

A

Erodes through the gallbladder directly into the small intestine creating a fistula
The stone passes along the small bowel and creates an obstruction usually at the distal ileum

116
Q

What demographic usually gets a gallstone ileus?

A

Elderly

117
Q

What is the imaging of choice for a gallstone ileus and what will it show?

A

Plain films of the abdomen – SBO with intrahepatic biliary air and a calcification in the RLQ

118
Q

What is the treatment for a gallstone ileus?

A

NGT
IVF
Enterotomy with stone extraction +/- cholecystectomy and fistula repair

119
Q

What demographic is at highest risk for galbladder cancer?

A

American Indians and Hispanics

women>men

120
Q

What are the risk factors for gallbladder cancer?

A 
cholesterol gallstones
single large gallstone
calcified GB (porcelain)
biliary Salmonella typhi infection
biliary polyps > 1 cm
121
Q

What are the sx of early gallbladder cancer?

A

asymptomatic or that of biliary colic

122
Q

What are the sx of advanced GB cancer?

A

Vague RUQ pain, weight loss and malaise
Jaundice in 50%
Hard mass in RUQ – may be non-tender

123
Q

What is the only cure for GB cancer?

A

complete surgical removal
Cholecystectomy alone if only at peritoneal surface (rare)
En bloc resection of the gallbladder, liver bed, and lymph nodes
Formal liver resection

124
Q

What is the 5 year survival rate for GB cancer?

A

<5%

125
Q

What is Cholangiocarcinoma?

A

Malignancy of the biliary duct system

Intrahepatic, extrahepatic (perihilar), and distal extrahepatic

126
Q

In what demographic is Cholangiocarcinoma seen?

A

Equal among sexes

50 – 70 year old

127
Q

How does cholangiocarcinoma progress?

A

Slow growing but advance locally and are usually non-resectable at diagnosis

128
Q

What are the most common tumors seen in cholangiocarcinoma and where are they located?

A

Klatskin (perihilar) tumors

At the bifurcation of right and left hepatic ducts

129
Q

What are the risk factors for cholangiocarcinoma?

A

UC
Sclerosing cholangitis
Choledochal cysts
Parasitic disease

130
Q

What are the sx of cholangiocarcinoma?

A 
Most common sx is jaundice (progressive)
Pruritis 
Weight loss 
Abdominal pain
Cholangitis
131
Q

What will the physical show for cholangiocarcinoma?

A

Yellow
Hepatomegaly
May have Curvoisier’s sign

132
Q

What is Curvoisier’s sign?

A

Enlarged palpable gallbladder in patient with jaundice. Dilation of GB with thin walls

133
Q

What will show on labs for cholangiocarcinoma?

A

same as choledocholethiasis except bilirubin can get much higher

134
Q

What imaging can be used to evaluate cholangiocarcinoma?

A

US, CT, MRI

PTC, ERCP, EUS – can biopsy

135
Q

What is the treatment for cholangiocarcinoma?

A

Resection if cure is a possibility

Bypass or stent for symptom relief

136
Q

What is the 5 year survival rate of cholangiocarcinoma with resection?

A

5-25%

Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions