CIS High Yield Handouts

Question 1

Brown pigment stones tend to form in ____ ____ as a result of bacterial infections.

Answer 1

Bile duct

Question 2

What are the 6 F’s for gallstones?

Answer 2

FHx
Fair
Fat
 Female 
Fertile 
(Forty)

Question 3

What are protective modifications to prevent Gallstones?

Answer 3

Low carbohydrate diet
Physical activity
Cardio respiratory fitness
Caffeinated coffee (women)
High intake of Mg and polyunsaturated and monounsaturated fats in Men
High fiber diet and statin 
ASA and NSIADs

Question 4

What is ascending cholangitis?

Answer 4

Infection of the biliary tract secondary to bile duct obstruction or bile stasis, duodenal microorganism ascend
Due to choledocholithiasis, pancreatic/biliary neoplasm, postop strictures, choledocholithiasis cysts

Question 5

What organisms are involved in ascending cholangitis?

Answer 5

Gram -: e. Coli, klebsiella, enterobacter
Gram +: enterococcus species
Anaerobes: bactericides fragility and clostridia

Question 6

What is Charcot Triad?

Answer 6

Jaundice
Fever > 102
RUQ pain

Question 7

What is Reynolds pentad?

Answer 7

Carcot’s triad + mental status changes and hypotension

Question 8

What is the Rx of ascending cholangitis?

Answer 8

Endoscopic emergency -> Urgent ERCP (w/in 12-24 hours)

Diagnostic and therapeutic

Question 9

What is the diagnostic study of choic for cholecystokininase due to cholelithiasis?

Answer 9

ultrasound

Question 10

A HIDA scan may dx _______?

Answer 10

Biliary dyskinesia

Question 11

What is the empiric antibiotic therapy for gram negative and anaerobic organism causing cholangitis?

Answer 11

1. Beta-lactam/beta-lactam inhibitor: ampicillin, piperacillin, ticarcillin
   —or 3rd gen. Cephalosporin + metronidazole

Question 12

What labs should be ordered for a pt w/ cholangitis?

Answer 12

AST/ALT, alk phos, blood cultures, fractionated bilirubin, amylase/ lipase (pancreatitis)
—pre-procedure INR
—follow blood culture and bile cultures

Question 13

What are possible complication of status post ERCP?

Answer 13

Pancreatitis
Ascending cholangitis
Less common: hemophilia, perforation

Question 14

What is Mirizzi syndrome?

Answer 14

Common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct
—presence of a cholecystenteric fistula

Question 15

What is the normal diaphragm excursion?

Answer 15

3 to 5.5 cm

Question 16

Describe bronchophony?

Answer 16

Spoken words become louder and clearer due to pneumina, consolidations, effusion, etc.

Question 17

Describe egophony?

Answer 17

The ‘ee’ sound like ‘A’-nasal bleating quality and should be localized
If fever and cough = pneumonia

Question 18

When do you suspect choledocholithiasis on US?

Answer 18

Common bile duct is > 6 mm
—non-elderly, with an intact gallbladder 3-6mm
—elderly Pr post cholecystectomy > 10mm