Biliary tract disorders Flashcards
Cholelithiasis- Eti
- Most commonly cholesterol stones
- Fat, female, forty
- Pima & American- high incidence
Cholelithiasis- Sx
- Asymptomatic
- Infrequent, steady severe pain in epigastrum, RUQ
- Sx present at night, resolve in 2-6 hrs
Cholelithiasis- Dx
- US, may not be visible
Cholelithiasis- Tx
- Nothing- NSAIDs for pain
- Resection if needed
Acute cholecystitis- Eti
- 90% due to gallstone impaction & subsequent inflammation
- Acalculous rare- in critically ill patient, infectious agent
Acute cholecystitis- Sx
- Precipitated by large/ fatty meal
- Sudden, severe in epigastrum & rt hypochondrium
- Vomiting reliefs
- RUQ tenderness
- Palpable gallbladder
Acute cholecystitis- Dx
- Hepatobiliary nuclear imaging to show obstruction
Acute cholecystitis- Tx
- Cholecystectomy
- Subsides with conservative measures- abx, iv feeding, analgesics
Chronic cholecystitis- Eti
Repeated episodes of acute or chronic gallbladder irritation
Chronic cholecystitis- Tx
Cholecystectomy
Choledocholithiasis- Eti
- 15% of pt with gallstones
- Rise with age
- Stones in bile duct
Choledocholithiasis- Sx
- Hx of biliary pain with jaundice
- N/V
- Recurring RUQ pain persists for hrs
- Hepatomegaly
Choledocholithiasis- Dx
- ERCP
Choledocholithiasis- Tx
- Dilation & removal of stones with ERCP
Biliary Tract Carcinoma- Eti
- 10-25% of hepatobiliary malignancy
- 50-70 asian males
- Hx of gall infections, polyps
Biliary Tract Carcinoma- Sx
- Progressive jaundice
- RUQ pain radiates to back
- Fistula formation
- Rapid deterioration
- Palpable gallbladder
- Pruritis & skin excoriations
Biliary Tract Carcinoma- Dx
- MRI
- Cholangiography with biopsy
- Fine needle aspiration
Biliary Tract Carcinoma- Tx
- Resection or biliary-enteric bypass
- Palliation
Cholangitis- Sx
- Charcot triad: pain, fever, & jaundice
- Chills
- AMS & hypotension
- Shock & leukocytosis
Cholangitis- Dx
ERCP
Cholangitis- Tx
Cipro
Primary biliary cirrhosis- Eti
- Middle aged women
- Insidious onset
- Hx of UTI, smoking, hormone, hair dye
Primary biliary cirrhosis- Sx
- Asymptomatic
- Fatigue & pruritis
- Hepatosplenomegaly
- Xanthomatous lesions
- Steatorrhea, portal HTN
- Orthostatic hypotension, cognitive dysfunction
- Low bone density
Primary biliary cirrhosis- Dx
Liver biopsy
Primary biliary cirrhosis- Tx
- Ursodeoxycholic acid
Primary sclerosing cholangitis- Eti
- 20-50 males
- Assoc with ulcerative colitis
- 10% risk of cholangiocarcinoma
Primary sclerosing cholangitis- Sx
- Progressive obstructive jaundice
- Fatigue, pruritis, anorexia, indigestion
- Esophageal varicies
Primary sclerosing cholangitis- Dx
- MR choliangiography
- Onion-skinning of liver- biopsy
Primary sclerosing cholangitis- Tx
- Cipro
- Ursodeoxycholic acid
- Balloon dilation
- Stenting
