Biliary Tract Diseases

Question 1

Primary Sclerosing Cholangitis

Answer 1

Sclerosis = onion skin

Associated w/ UC and p-ANCA

intra and extra hepatic bile ducts

Question 2

PBC

Answer 2

Primary Biliary Cholangitis

Primary so intrahepatic

Anti-AMA and granulomas

Question 3

Secondary Biliary Cholangitis

Answer 3

Secondary so extrahepatic

OBSTRUCTION so backs up into intrahepatic and causes stasis / fibrosis

Question 4

How do stones lead to air in biliary tree?

Answer 4

Gall bladder to GI fistula –> air into tree and gallstones in duodenum

The stone then gets stuck at ileocecal valve leading to gallstone ileus (smallest lumen)

Question 5

Risk for Cholesterol Gallstones

Answer 5

Fertile, Female, Forty, Fat (estrogen, mult babies, obesity)

Rapid wt loss

Native American origin

Question 6

2 Types of Cholecystitis

Answer 6

Calculous - MORE COMMON - stone at neck of gallbladder leading to wall thickening - can cause secondary infection

Acalculous - gallbladder stasis, hypoperfusion or CMV in critically ill

Both = Murphy Sign (RUQ pain and insp arrest on palpation)

Question 7

Ascending Cholangitis Diagnostic Criteria

Answer 7

AKA biliary tree - due to obstruction

Charcot Triad:
1 - Jaundice
2- Fever
3- RUQ pain

Reynold’s Pentad:
4- Altered mental status
5- Shock / hypotension

Question 8

Causes of Acute Pancreatitis

Answer 8

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune 
Scorpion sting 
Hypercalcemia or Hyper-TGs
ERCP
Drugs (sulfa, NRTIs, protease inhibitors)

Question 9

2 Types of Pigmented Gallstones

Answer 9

Black - radio-opaque from Ca, bilirubin and hemolysis

Brown - infection (radiolucent)