Clinical- Billiary And Jaundice Disorders Flashcards
How does biliary dyskinesia present
- Right upper quadrant pain
- Severe pain that limits daily life
- Nausea with episodes of pain
Which tests should be done on a patient before performing an ERCP
- measure INR (clotting factors)
- Pregnancy test
- Kidney function (if using dye)
How is biliary dyskinesia diagnosed
Right upper quadrant pains (similar to biliary colic)
-Diagnosed with a normal ultrasounds of the gallbladder
If we get a GGT (gamma glutamyl transferase), and it is elevated, what is the most likely source of the jaundice
The liver source
What is the diagnostic test finding on ultrasound to indicate gallstones
Acoustic shadowing
What is the cause of choledocholithiasis
Stones in the bile duct
What is charcot triad an indication for
Ascending cholangitis
What is Murphys sign
Deep inspiration or coughing during inspiration in the RUQ produces pain or inspiration arrest
What are signs of choledocholithiasis
- frequent attacks of RUQ pain persisting for hours
- chills and fever with pain
- history of jaundice and ab pain
What is the only hyperbilirubinemia associated with unconjugated bilirubin
Gilbert syndrome
What is considered to be an abnormal ejection fraction of a HIDA (hepatic iminodiacetic acid) scan
Less than 35-38% —> cholecystectomy
What are the suggestive findings of acute cholecystitis on ultrasoundography
- Gallbladder wall thickening
- pericholecystic fluid
- sonography Murphys sign
What can choledocholithiasis lead to
Acute ascending cholangitis (AC)
What condition is associated with primary sclerosing cholangitis
UC
What is the most reliable detection of stones in the bile duct
ERCP or EUS
What is the method used to look for an obstructive jaundice
Aka conjugated jaundice
-Ultrasonography followed by a cholangiography
What is the procedure of choice for choledocholithiasis
ERCP with sphincterotomy and stone extraction, or a stent placement
What are the labs associated with primary sclerosing cholangitis
Elevated alkaline phosphatase, GGT
-p-ANCA antibodies
What constitutes Charcot triad
- RUQ pain
- Fever chills
- Jaundice
What does Raynaud pentad signify
Acute suppurative cholangitis and a medical emergency
What are the imaging findings in primary sclerosing cholangitis
“Beads on a string”
“Onion skin”
What is Reynold pentad
- Fever/chills
- RUQ pain
- jaundice
- Altered mental status
- hypotension
What is biliary colic
-Severe steady ache in the RUQ or epigastric, can radiate the back scapula
What is the serology finding in primary biliary cirrhosis
Anti-AMA
What is the best diagnostic test for gallstones
Ultrasonography
What is a a HIDA scan and what is being looked at
Radionucletide scan, where the gall bladder should be visualized within an hour if normal
What is a common reason to have slightly elevated aminotransferase levels (ALT and AST)
Nonalcoholic fatty liver disease
What are the complications of acute cholecystitis
- Gangrene of the gall bladder (splanchnic vasoconstriction)
- perforation with formation of a pericholecystic abcess
- occasionally generalized periodonitis
- Emphysematous cholecystitis (secondary infection with gas forming bacteria)
- empyema
What are the complications associated with endoscopic retrograde cholangiopancreatography
Pancreatitis, bleeding, infections, perforations
What is the cause of over 90% of cases of acute cholecystitis
Gallstones in the cystic duct
What is an abnormal HIDA scan and what is the diagnosis
If the gallbladder is not seen within an hour, then abnormal due to stone in cystic duct or cholecystitis
What are the lab findings indicative of choledocholithiasis
- Huge increase in ALT/AST
- Alkaline phosphate and GGT rise
- serum amylase if secondary pancreatitis
What are the complications associated with Primary sclerosing cholangitis
Osteoporosis and vitamin absorption
Cholangiocarcinoma
What is the prognosis in a patient with porcelain gallbladder
Poor, as indicated calcification and increased risk of gallbladder cancer
Increased amounts of unconjugated bilirubin is usually due to what
Increased bilirubin production as a result of hemolytic reactions or impaired uptake of bilirubin
What not gallbladder related complication is associated with courvoisiers sign
Pancreatic cancer of the head
What condition is common if fasting increases the amount of bilirubin in the blood
Gilbert’s syndrome
What is the xray finding in a patient with chronic cholecystitis
Porcelain gallbladder
What are the protective factors against gallstones
- Low carb
- Physical activity (cardiorespiratory fitness)
- caffeine in women
- High Mg intake
- High fiber and statin diet
- ASA and NSAIDs
What is the increased risk associated with primary sclerosing cholangitis
Cholangiocarcinoma
What is biliary dyskinesia and what is the common cause
Symptomatic functional disorder of the gallbladder with an unknown etiology
Which normally bad habit decreases the risk of UC and PSC
Smoking
Which patient population is prone to pigmented stone
Asian Americans
What are the lab results that accompany a biliary dyskinesia
Normal liver enzymes, conjugated bilirubin, and amylase/lipase
If we get a GGT (gamma glutamyl transferase) and the levels are normal, what is the likely source
Bone or other growing source (placenta)
