Cholestatic Diseases Flashcards
What is Cholestasis?
Reduced bile flow
Chronic Cholestasis is often caused by what general things?
Cancer
Strictures
Autoimmune conditions
Chronic Cholestasis will present as Obstructive Jaundice. List signs.
- Jaundice
- Pruritus
- Xanthelasma
- Clay-colored stools
Chronic Cholestasis will present as Obstructive Jaundice. List signs.
- Jaundice
- Pruritus
- Xanthelsama
- Clay-colored stool
In general what 3 diagnostic tests should be done with signs of Obstructive Jaundice are present?
- MRCP
- CT with IV contrast
- Biopsy
What are 2 risk factors for a Pancreatic Adenocarcinoma?
Smoking
Chronic Pancreatitis
Where in the pancreas must the Pancreatic Adenocarcinoma be to cause Obstructive Jaundice?
Head
What mutations are commonly present with Pancreatic Adenocarcinomas?
KRAS
CDKN2A
What 3 tests should be done for a Pancreatic Adenocarcinoma?
- MRCP
- CT with IV contrast
- Endoscopic ultrasound biopsy
What is the treatment for a Pancreatic Adenocarcinoma?
Whipple surgery
Describe the Whipple surgery?
Removes:
- Distal stomach/pylorus
- Duodenum
- Pancreas
- Proximal jejunum
- Gallbladder and common bile duct
What is a Cholangiocarcinoma?
Bile duct malignancy
What are 2 risk factors for a Cholangiocarcinoma?
- Liver flukes in southeast Asia
- Primary Sclerosing Cholangitis
Most of the conditions in this deck will present with?
Obstructive jaundice signs
= Jaundice, itching, clay-colored stool, xanthelasma
Where does Hepatopancreatic Ampulla cancer occur?
Intraluminal mass at the ampulla of Vater
What are the results of the fecal occult blood test and colonoscopy with Hepatopancreatic Ampulla Cancer?
(+) fecal occult blood test
(-) colonoscopy
What is the treatment for Hepatopancreatic Ampulla Cancer?
Whipple surgery
What causes Gallbladder cancer?
Chronic gallstones
Describe what will be present with Gallbladder cancer
Distended and palpable gallbladder that is NONtender
Will the distended gallbladder be tender with Gallbladder cancer?
NO
How does the Gallbladder look on imaging with gallbladder cancer?
“Porcelain gallbladder” – calcified
What is Mirizzi’s Syndrome?
Gallstones in the cystic duct leads to Common Bile Duct proximal occlusion
Gallstones in the cystic duct leads to Common Bile Duct proximal occlusion
Mirizzi’s Syndrome
What general signs will be present with Mirizzi’s Syndrome?
Cholecystitis findings + Choledocholithiasis findings
What are 3 risk factors for Acute Pancreatitis?
High triglycerides
Alcohol
Gallstones
What occurs with Acute Pancreatitis?
Autodigestion of the pancreas due to early activation of the zymogens (enzymes)
What symptoms will be present with Acute Pancreatitis?
Epigastric pain that radiates to the back
- pain is worse with eating
- N/V
What symptoms will be present with Acute Pancreatitis?
Epigastric pain that radiates to the back
- Pain is worse with eating
- N/V
To diagnose Acute Pancreatitis, you must have 2/3 of the following:
- Epigastric pain
- Lipase that is > 3x the upper limit of normal
- CT changes consistent with pancreatitis
What CT changes are consistent with Acute Pancreatitis?
Peripancreatic fat stranding
What is the treatment for Acute Pancreatitis?
NPO, IVF and pain control until able to tolerate food
What causes Chronic Pancreatitis?
Repeated bouts of Acute Pancreatitis
What are the signs of Chronic Pancreatitis?
- Chronic epigastric pain
- Diabetes Mellitus
- Malabsorption
What will be seen on MCRP with Chronic Pancreatitis?
Chains of lakes
What will be seen on CT with Chronic Pancreatitis?
Atrophy and calcifications
What is the treatment for Chronic Pancreatitis?
Pain control, Insulin for DM, enzymes for malabsorption
What are those with Chronic Pancreatitis at an increased risk for?
Pancreatic Adenocarcinoma
In order to diagnose Acute Pancreatitis, the patient must have 2/3 of the following:
- Epigastric pain
- Lipase > 3x the upper limit of normal
- CT changes
What is Primary Sclerosing Cholangitis and in what gender is it more common?
Fibrosis/strictures of the intrahepatic AND extrahepatic bile ducts
– More common in Males
What other disease process does Primary Sclerosing Cholangitis often present with?
Ulcerative colitis
Describe the symptoms of Primary Sclerosing Cholangitis?
Like Ascending Cholangitis
- RUQ pain
- Fever
- Jaundice
- Hypotension
- Altered mental status
What is Primary Biliary Cholangitis and what gender does it more commonly present in?
Autoimmune attack against intrahepatic bile ducts only
– More common in Females
