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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
How is porcelain GB tx?
cholecystectomy for incomplete calcification or sx pts w/complete calcification
26
What are cholesterol GB polyps?
benign | abnormal deposits of TGs & cholesterols into theGB mucosa
27
What is an adenomyomatosis polyp?
benign | overgrowth of the mucosa, thickening of the muscle wall and intramural diverticula
28
What is an inflammatory polyp?
benign | granulation and fibrous tissue w/plasma cells and lymphocytes
29
What is an adenoma polyp?
benign glandular tumor w/potential for malignancy
30
How to gallbladder polyps present?
can be asymptomatic biliary pain possible association of dyspepsia w/cholesterolosis and adenomyomatosis
31
How are GB polyps Dx?
transabd us endoscopic us CT
32
How are gallbladder polyps managed?
cholecystectomy | w/cholelithiasis, PSC, biliary colic/pancreatitis, polyps >10mm, drastic growth
33
Features of acute (ascending) cholangitis?
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
34
What type of bacteria typically cause acute cholangitits?
gram negative and positive colonic bacteria
35
What important clinical signs are present in acute cholangitis?
charcot's triad reynolds pentad cholestatis liver test elevations, leukocytosis
36
What is charcot's triad?
fever, abd pain, jaundice
37
What is Reynolds' pentad?
confusion, hTN w/charcot's triad (fever, abd pain, jaundice)
38
What is seen for acute cholangitis on imaging?
dilated biliary system, choledocholitiasis
39
How is acute cholangitis treated?
``` abx biliary drainage (via ERCP) ```
40
What is biliary atresia?
progressive, idiopathic, fibroobliterative disease of the extrahepatic biliary tree can be viral, toxic, genetic or due to immune dysregulation
41
How does biliary atresia present?
biliary obstruction exclusively in the neonatal period babies have normal birth weight/thrive initially jaundice birth to 8wks of age
42
What are the types of biliary atresia?
biliary atresia | biliary atresia splenic malformation
43
How is biliary atresia dx?
abd us liver biopsy cholangiogram
44
How is biliary atresia treated?
kasai procedure | liver transplant eventually
45
What are biliary cysts?
cystic dilations that may occur singly or in multiples throughout the biliary tree associated with abnormal pancreaticobiliary junction
46
Epidemiology of biliary cysts?
asian, women, kids and adults | usually present before age 10
47
What are the different types of biliary cysts?
type 1-extrahepatic type iv-mutliple cysts-extrahepatic +/- intrahepatic type v-intrahepatic, caroli's disease
48
What can presdispose to biliary cysts?
genetics/envrionment | developmental abnormalities
49
How are biliary cysts diagnosed?
abd US cholangiogrphay ct
50
What is the most important complication of biliary cysts?
increased risk for cholangiocarcinoma (type 1 and 4)
51
What is primary sclerosing cholangitis?
progressive inflammation, fibrosis and stricturing of the intrahepatic and extrahepatic bile ducts
52
Association of PSC?
w/IBD (UC>Crohn's)
53
Epidemiology of PSC?
men, 40, women dx at later age
54
How does PSC occur?
``` Immune activation: humoral and cellular abnormalities genetic factors bacterial? ischemia? CF ```
55
How does PSC present?
``` asymptomatic elevated liver tests in cholestatic pattern fatigue pruritus jaundice hypergammaglobulinemia P-ANCA ```
56
What are the types of PSC?
Classic (intrahepatic & extrahepatic, intrahepatic only, extrahepatic only) Smll Duct
57
How is PSC dx?
CT abd US cholangiography (MRI ERCP) liver biopsy (not necessary)
58
What is a histologic feature of PSC?
onion skin pattern around bile ducts
59
What are complications of PSC?
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
How is PSC treated?
ERCP for dominant extrahepatic strictures | Surgery-biliary reconstruction/liver transplantation
61
What is AIDS cholangiopathy?
biliary obstruction resulting from infection-related (crypto) strictures of the biliary tract usuallly pts w CD4 <100
62
How does AIDS cholangiopathy present?
RUQ & epigastric pain, diarrhea | cholestatic liver enzyme elevations
63
How to dx AIDS cholangiopathy?
transabd us mrcp ercp
64
How to tx AIDS cholangiopathy?
biliary sphincterotomy stenting of dominant extrahepatic stricutres Ursodeoxycholic acid maybe
65
What parasites most commonly cause biliary parasitosis?
``` ascaris lumbricoides echinococcus granulosus clonorchis sinensis opisthorchiasis fasciola hepatica ```
66
Features of Ascaris lumbricoides biliary parasitosis?
roundworm US ERCP for dx and removal anti-helminthic therapy
67
Features of echinococcus granulosus biliary parasitosis?
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
Features of clonorchis sinensis (&opisthorchiasis) biliary parasitosis?
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
Features of fasciola hepatic biliary parasitosis?
from eating raw veggies infected w/metacercariawe penetrate duodenum, migrate and enter biliary system ERCP for acute cholangitis tx w/anti helminthis therapy
70
What is recurrent pyogenic cholangitis?
pigment stone formation in the intrahepatic biliary system resulting in intrahepatic stricutring and biliary obstruction w/recurrent bouts of acute cholangitis
71
Who gets recurrent pyogenic cholangitis?
pts from SE Asia
72
Sx of recurrent pyogenic cholangitis?
acute cholangitis
73
Dx of recurrent pyogenic cholangitis?
abd us, mri, ct, ptc, ercp
74
What can cause recurrent pyogenic cholangitis?
biliary parasitosis bacterial infection stasis
75
Tx for recurrent pyogenic cholangitis?
tx acute cholangitis stone clearance ursodeoxycholic acid ? hepatic resection & renastomosis
76
Prognosis for recurrent pyogenic cholangitis?
cirrhosis from secondary sclerosis cholangitis | increased risk of cholangiocarcinoma
77
What is Cholelithiasis?
stones/sludge in the gallbladder | usually asymptomatic
78
Who gets gallstones?
fat, fertile, forty, female
79
How can cholelithiasis manifest?
``` biliary colic (intermittent cystic duct obstruction) asymptomatic ```
80
Dx cholelithiasis?
transabd US | endoscopic US
81
Tx cholelithiasis?
prophylacic cholecystectomy w/risk factors (sickle cell, hereditary spherocytosis, gastric bypass surgery) cholecystectomy w/biliary colic sx
82
What is choledocholithiasis?
stones/sludge in the common bile duct, secondary to passage of cholelithiasis usually
83
Sx of choledocholithiasis?
asymptomatic intermittent RUQ pain nausea & vomiting elevated liver test in cholestatic pattern
84
Dx of choledocholithiasis?
abd us endoscopic us cholangiography (ercp, mrcp)
85
What is Mirizzi syndrome?
common hepatic duct obstruction from extrinsic compression by an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder
86
What are the sx of Mirizzi syndrome?
``` jaundice RUQ pain Fever Elevated liver tests in a cholestatic pattern assoc. w/GB cancer ```
87
How is Mirizzi sndrom dx?
abd ultrasound | cholangiogrphay
88
Tx for Mirizzi syndrome?
surgery | -cholecystectomy +/- bilioenteric anastomosis

GI (20 decks)

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