Clinical Approach to the Hepatobiliary Patient: Biliary Tree and Gallbladder

Question 1

what is biliary colic?

Answer 1

a severe steady ache in the RUQ or epigastrium that begins suddenly

Question 2

what could causes acalculous cholecystitis?

Answer 2

acute illness (burns, trauma, major surgery), vasculitis, carcinoma, some gallbladder infections

Question 3

in what lab do you get an ALP?

Answer 3

CMP

Question 4

what are the findings suggestive of acute chplecystitis on a RUQ US?

Answer 4

gallbladder wall thickening, pericholecystic fluid, and a sonographic Murphy sign

Question 5

what are the complications associated with acute cholecystitis?

Answer 5

gangrene of the gallbladder and emphysematous cholecystitis

Question 6

what is emphysematous cholecystitis?

Answer 6

secondary infection with a gas-forming organism

Question 7

what is a risk factor for emphysematous cholecystitis?

Answer 7

uncontrolled DM

Question 8

what does an US show in a patient with chronic cholecystitis?

Answer 8

usually gallstones within a contracted gallbladder

Question 9

what are the complications associated with chronic cholecystitis?

Answer 9

porcelain gallbladder- calcified lesion- there is an increased risk of gallbladder cancer (which has a poor prognosis)

Question 10

what is courvoisier”s gallbladder associated with?

Answer 10

cancer of the head of the pancreas

Question 11

what might the labs show in a patient with choledocholithiasis?

Answer 11

transient/striking increase in transaminases, hyperbilirubinemia (direct), Alk Phos and GGT elevated, serum lipase and amylase elevations (secondary pancreatitis)

Question 12

what imaging modality do you use to diagnose choledocholithiasis?

Answer 12

ERCP- CHECK INR FIRST

Question 13

what is the procedure of choice when high suspicion of CBD stone?

Answer 13

ERCP with sphincterotomy and stone extraction/stent placement

Question 14

what two sets of symptoms are associated with ascending cholangitis?

Answer 14

Charcot’s triad and reynold’s pentad

Question 15

what is Charcot’s triad?

Answer 15

fever, RUQ pain, and jaundice

Question 16

what is reynold’s pentad?

Answer 16

fever, RUQ pain, jaundice, AMS, and hypotension

Question 17

what are the most common microbes to cause ascending cholangitis?

Answer 17

e. coli, Klebsiella, enterococcus

Question 18

what is an abnormal ejection fraction from the gallbladder considered to be?

Answer 18

anything less than 35-38%

Question 19

what is the imaging modality for PSC and what does it show?

Answer 19

MRCP/ERCP: beads on a string

Question 20

what are the complications associated with PSC?

Answer 20

increased risk of cholangiocarcinoma, colon ca, ascending cholangitis

Question 21

how is PBC characterized?

Answer 21

autoimmune destruction of small intrahepatic bile ducts and cholestasis

Question 22

what are the clinical manifestations associated with PBC?

Answer 22

asymptomatic isolated alk phos; pruritus, fatigue, progressive jaundice, xanthelasma

Question 23

what are the diagnostics used for PBC?

Answer 23

increased serum alk phos and AMA in 90-95% of patients

Question 24

how can you treat PBC?

Answer 24

ursodeoxycholic acid, cholestyramine with meals for pruritus; liver transplantation for end-stage disease