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GI > Biliary Tract & Gallbladder Disease > Flashcards

Biliary Tract & Gallbladder Disease Flashcards

1
Q

Define cholecystits

A

gallbladder inflammation

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2
Q

What are the symptoms of acute cholecystitis?

A

RUQ pain (prolongued/steady) +/- radiation to shoulder or back, fever, leukocytosis, gallbladder inflammation, gallstones, abdominal guarding

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3
Q

What is murphy’s sign?

A

increased discomfort when pt take a deep breath in while examiner palpates RUQ

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4
Q

What are the symptoms of chronic cholecystitis?

A

gallstones, no correlation with symptoms

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5
Q

How to dx acute cholecystitis?

A

abdominal ultrasound
HIDA scan
CT

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6
Q

What are some complications of acute cholecystitis?

A

gangrene
perforation
cholecystoenteric fistula
emphysematous cholecystitis

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7
Q

Where do cholecystoenteric fistulas usually open up?

A

duodenum or jejunum

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8
Q

What is gallstone ileus?

A

passage of gallstone through CE fistula, mechanical bowel obstruction, usually in termina ileum

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9
Q

What is emphysematous cholecystitis?

A

2ary infection of gallbladder wall with gas-forming organisms
leads to gangrene and perforation

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10
Q

How is acute cholecystitis treated?

A 
may ablate in 7-10 days w/o tx
abx
pain control (NSAIDS)
gallbladder drainage
Surgery
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11
Q

How does acalculous cholecystitis?

A

gallbladder stasis & ischemia -> local inflammatory response -> secondary infection
ie/w TPN b/c GB not used as much

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12
Q

How does acalculous cholecystitis present?

A

hospitalized, critically ill pts

unexplained fever, leukocytosis, abd pain

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13
Q

Dx of acalculous cholecystitis?

A

abdominal ultrasound
murphy’s sign
HIDA scan
CT

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14
Q

TX of acalculous cholecystitis?

A

abx

percutaneous or surgical cholecystectomy

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15
Q

Mortality of acute cholecystitis?

A

3%

likely b/c presents in older patients

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16
Q

Mortality of acalculous cholecystitis?

A

30%

75% w/delayed tx

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17
Q

What is xanthrogranulomatous cholecystitis?

A

extravasation of bile into the gallbladder wall, leads to inflammatory reaction and xanthoma cells
gallstones ALWAYS present

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18
Q

How does xanthrogranulomatous cholecystitis present?

A

hisotry or acute cholecystitis
can mimic gallbladder cancer
high rate of complications

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19
Q

How is xanthrogranulomatous cholecystitis diagnosed?

A

abd US

CT

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20
Q

How is xanthrogranulomatous cholecystitis treated?

A

cholecystectomy

preoperative cholangiogram to exclude bile duct cancer

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21
Q

What is porcelain gallbladder?

A

chronic cholecystitis with intramural calcification of the gallbladder wall

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22
Q

What is the epidemiology of porcelain gallbladder?

A

uncommon, more common in females

increased risk of gallbladder cancer (esp w/incomplete calcification)

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23
Q

How does procelain gallbladder present?

A

asymptomatic
biliary type pain
palpable gallbladder

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24
Q

How is procelain GB dx?

A

abd xray
ct
abd us

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25
Q

How is porcelain GB tx?

A

cholecystectomy for incomplete calcification or sx pts w/complete calcification

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26
Q

What are cholesterol GB polyps?

A

benign

abnormal deposits of TGs & cholesterols into theGB mucosa

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27
Q

What is an adenomyomatosis polyp?

A

benign

overgrowth of the mucosa, thickening of the muscle wall and intramural diverticula

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28
Q

What is an inflammatory polyp?

A

benign

granulation and fibrous tissue w/plasma cells and lymphocytes

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29
Q

What is an adenoma polyp?

A

benign glandular tumor w/potential for malignancy

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30
Q

How to gallbladder polyps present?

A

can be asymptomatic
biliary pain
possible association of dyspepsia w/cholesterolosis and adenomyomatosis

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31
Q

How are GB polyps Dx?

A

transabd us
endoscopic us
CT

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32
Q

How are gallbladder polyps managed?

A

cholecystectomy

w/cholelithiasis, PSC, biliary colic/pancreatitis, polyps >10mm, drastic growth

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33
Q

Features of acute (ascending) cholangitis?

A

fever, jaundice, abd pain that develops as a result of stasis and infection in the biliary tract due to bacteria entering from the SI or portal system, this causes disruption of the sphincter of oddi

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34
Q

What type of bacteria typically cause acute cholangitits?

A

gram negative and positive colonic bacteria

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35
Q

What important clinical signs are present in acute cholangitis?

A

charcot’s triad
reynolds pentad
cholestatis liver test elevations, leukocytosis

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36
Q

What is charcot’s triad?

A

fever, abd pain, jaundice

37
Q

What is Reynolds’ pentad?

A

confusion, hTN w/charcot’s triad (fever, abd pain, jaundice)

38
Q

What is seen for acute cholangitis on imaging?

A

dilated biliary system, choledocholitiasis

39
Q

How is acute cholangitis treated?

A 
abx
biliary drainage (via ERCP)
40
Q

What is biliary atresia?

A

progressive, idiopathic, fibroobliterative disease of the extrahepatic biliary tree
can be viral, toxic, genetic or due to immune dysregulation

41
Q

How does biliary atresia present?

A

biliary obstruction exclusively in the neonatal period
babies have normal birth weight/thrive initially
jaundice birth to 8wks of age

42
Q

What are the types of biliary atresia?

A

biliary atresia

biliary atresia splenic malformation

43
Q

How is biliary atresia dx?

A

abd us
liver biopsy
cholangiogram

44
Q

How is biliary atresia treated?

A

kasai procedure

liver transplant eventually

45
Q

What are biliary cysts?

A

cystic dilations that may occur singly or in multiples throughout the biliary tree
associated with abnormal pancreaticobiliary junction

46
Q

Epidemiology of biliary cysts?

A

asian, women, kids and adults

usually present before age 10

47
Q

What are the different types of biliary cysts?

A

type 1-extrahepatic
type iv-mutliple cysts-extrahepatic +/- intrahepatic
type v-intrahepatic, caroli’s disease

48
Q

What can presdispose to biliary cysts?

A

genetics/envrionment

developmental abnormalities

49
Q

How are biliary cysts diagnosed?

A

abd US
cholangiogrphay
ct

50
Q

What is the most important complication of biliary cysts?

A

increased risk for cholangiocarcinoma (type 1 and 4)

51
Q

What is primary sclerosing cholangitis?

A

progressive inflammation, fibrosis and stricturing of the intrahepatic and extrahepatic bile ducts

52
Q

Association of PSC?

A

w/IBD (UC>Crohn’s)

53
Q

Epidemiology of PSC?

A

men, 40, women dx at later age

54
Q

How does PSC occur?

A 
Immune activation: humoral and cellular abnormalities
genetic factors
bacterial?
ischemia?
CF
55
Q

How does PSC present?

A 
asymptomatic
elevated liver tests in cholestatic pattern
fatigue
pruritus
jaundice
hypergammaglobulinemia
P-ANCA
56
Q

What are the types of PSC?

A

Classic (intrahepatic & extrahepatic, intrahepatic only, extrahepatic only)
Smll Duct

57
Q

How is PSC dx?

A

CT
abd US
cholangiography (MRI ERCP)
liver biopsy (not necessary)

58
Q

What is a histologic feature of PSC?

A

onion skin pattern around bile ducts

59
Q

What are complications of PSC?

A

cirrhosis, portal HTN, (due to progressive hepatic fibrosis) steatorrhea, fat soluble viamin malabsoroption (decreased bile acids), osteoporosis (unknown), dominant biliary structures, acute cholangitis, cholelithiasis, hepatobiliary cancers (cholangiocarcinoma), colon cancer

60
Q

How is PSC treated?

A

ERCP for dominant extrahepatic strictures

Surgery-biliary reconstruction/liver transplantation

61
Q

What is AIDS cholangiopathy?

A

biliary obstruction resulting from infection-related (crypto) strictures of the biliary tract
usuallly pts w CD4 <100

62
Q

How does AIDS cholangiopathy present?

A

RUQ & epigastric pain, diarrhea

cholestatic liver enzyme elevations

63
Q

How to dx AIDS cholangiopathy?

A

transabd us
mrcp
ercp

64
Q

How to tx AIDS cholangiopathy?

A

biliary sphincterotomy
stenting of dominant extrahepatic stricutres
Ursodeoxycholic acid maybe

65
Q

What parasites most commonly cause biliary parasitosis?

A 
ascaris lumbricoides
echinococcus granulosus
clonorchis sinensis
opisthorchiasis
fasciola hepatica
66
Q

Features of Ascaris lumbricoides biliary parasitosis?

A

roundworm
US
ERCP for dx and removal
anti-helminthic therapy

67
Q

Features of echinococcus granulosus biliary parasitosis?

A

tapeworms w/canine host
rupture of hepatic cyst into biliary system
jaundice & hepatomegaly
surgical resection or percutaneous injection of scolicidal agents & anti helminthic therapy

68
Q

Features of clonorchis sinensis (&opisthorchiasis) biliary parasitosis?

A

far east/east russia (SE asia, central & e europe)
asymptomatic, cholangitis
chronic infection associated w/cholangiocarcinoma
ERCP for acute cholangitis
tx w/antihelminthic tx

69
Q

Features of fasciola hepatic biliary parasitosis?

A

from eating raw veggies infected w/metacercariawe
penetrate duodenum, migrate and enter biliary system
ERCP for acute cholangitis
tx w/anti helminthis therapy

70
Q

What is recurrent pyogenic cholangitis?

A

pigment stone formation in the intrahepatic biliary system resulting in intrahepatic stricutring and biliary obstruction w/recurrent bouts of acute cholangitis

71
Q

Who gets recurrent pyogenic cholangitis?

A

pts from SE Asia

72
Q

Sx of recurrent pyogenic cholangitis?

A

acute cholangitis

73
Q

Dx of recurrent pyogenic cholangitis?

A

abd us, mri, ct, ptc, ercp

74
Q

What can cause recurrent pyogenic cholangitis?

A

biliary parasitosis
bacterial infection
stasis

75
Q

Tx for recurrent pyogenic cholangitis?

A

tx acute cholangitis
stone clearance
ursodeoxycholic acid ?
hepatic resection & renastomosis

76
Q

Prognosis for recurrent pyogenic cholangitis?

A

cirrhosis from secondary sclerosis cholangitis

increased risk of cholangiocarcinoma

77
Q

What is Cholelithiasis?

A

stones/sludge in the gallbladder

usually asymptomatic

78
Q

Who gets gallstones?

A

fat, fertile, forty, female

79
Q

How can cholelithiasis manifest?

A 
biliary colic (intermittent cystic duct obstruction)
asymptomatic
80
Q

Dx cholelithiasis?

A

transabd US

endoscopic US

81
Q

Tx cholelithiasis?

A

prophylacic cholecystectomy w/risk factors (sickle cell, hereditary spherocytosis, gastric bypass surgery)
cholecystectomy w/biliary colic sx

82
Q

What is choledocholithiasis?

A

stones/sludge in the common bile duct, secondary to passage of cholelithiasis usually

83
Q

Sx of choledocholithiasis?

A

asymptomatic
intermittent RUQ pain
nausea & vomiting
elevated liver test in cholestatic pattern

84
Q

Dx of choledocholithiasis?

A

abd us
endoscopic us
cholangiography (ercp, mrcp)

85
Q

What is Mirizzi syndrome?

A

common hepatic duct obstruction from extrinsic compression by an impacted stone in the cystic duct or Hartmann’s pouch of the gallbladder

86
Q

What are the sx of Mirizzi syndrome?

A 
jaundice
RUQ pain
Fever
Elevated liver tests in a cholestatic pattern
assoc. w/GB cancer
87
Q

How is Mirizzi sndrom dx?

A

abd ultrasound

cholangiogrphay

88
Q

Tx for Mirizzi syndrome?

A

surgery

-cholecystectomy +/- bilioenteric anastomosis

GI (20 decks)

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