Chapter 16: Biliary Tract Flashcards
A 35 yo woman is referred for consideration of cholecystectomy following abdominal ultrasonography that was done to evaluate recurrent UTIs. A recommendation for obs w/o surgery would be made for the following condition:
Asymptomatic gallstones
note: gallstone pancreatitis, GB polyp, cholecystitis, choledocholithiasis require surgery
An 83 yo Asian man w/ a known hx of recurrent common bile duct stones presents w/ fever, jaundice, and RUQ pain. The treatment of this pt includes:
Resuscitation, IV Abx, and urgent ERCP to relieve the bile duct obstruction
A 62 yo man comes to your clinic b/c his wife noticed that his eyes were yellow. Otherwise he is feeling well, able to work, and has stable weight. His PMHx is notable for HTN and mild obesity. The lab tests reveal an Alk Phos of 412, total bilirubin of 7.2, AST 110, ALT 105. The most likely dx is:
Choledocholithiasis
A 54y o man w/ known dx of GS presents to the ER w/ abd pain and fever for the past 8 hours. He is oriented to time, place, and person. There is no jaundice. There is tenderness w/ guarding in the RUQ of the abd. Ultrasonography shows stones in the GB and normal caliber bile ducts. The most likely dx is:
Cholecystitis b/c pts with cholangitis are often jaundiced**
A 78 yo man is seen in the office for loss of appetite and abd discomfort for the last 3 days. His temp is 36.8C, HR 95, BP 100/60. His epigastrium mildly tender and he is sent for laboratory testing, after which he goes home. The lab tests reveal: WBC 11.5K, Hgb 16, a new increase in Cr from 0.7 to 1.3, a serum Na of 132, HCO3 of 18, amylase 250. For the pt’s follow up the most appropriate plan is to:
Ask the office staff to call the patient to the ER
A 75 yo man presents with jaundice. On imaging a large stone is identified in the neck of the GB where there is surrounding inflammation that involves the adjacent common hepatic duct. The biliary tree is dilated proximal to this area. The common bile duct distal to this is not dilated. Which one of the following is the most likely diagnosis?
Mirizzi’s syndrome
A 43 yo woman presents to your clinic complaining of RUQ pain following a fatty meal. She is of Native American descent. She is married and has 4 children. There is no hx of any hematological disorders. She does not drink alcohol. U/S demonstrates GS. Which of the following molecules is primary responsible for the formation of her GS:
Cholesterol
A 63 yo woman with repeated episodes of cholecystitis is being considered for cholecystomy. Past surgical hx includes an open appendectomy 40yrs ago and a hysterectomy 15 yrs ago. When counseling a patient about the risks and benefits between an open and laproscopic cholecystectomy, the patient should know that:
Laparoscopic cholecystectomy can be safely performed in patients who have already had open abdominal surgery
A 29 yo woman presents to the ER w/ abd pain, N/V. She is known to have GSs since her last pregnancy 2 yrs ago. Her laboratory results reveal normal hgb, plts, and WBC. The amylase, alk phos, and bilirubin are all elevated. She remains afebrile. After administering IVFs and meds for pain and nausea, what is the most reasonable next step?
ERCP w/ sphincterotomy and gallstone removal if lab values do not improve
A 38 yo woman is concerned about the risk for needing cholecysteomy after her 72 yo mother underwent cholecysteomy for cholecystitis. She takes meds for DM and HTN. She recently was treated for an E coli UTI. She has never been pregnant. Her biggest RF for the development of GS is:
Female gender
