Clinical Liver/Gallbladder - Bernadino

Question 1

Disease that is an autosomal dominant error of metabolism leading to unconjugated hyperbilirubinemia?

Answer 1

Glibert’s Syndrome
(UGT1A1)

Can increase with illness, fasting, stress, EtOH, nicotine, female periods

Question 2

Biliary tract obsruction will cause what type of hyperbilirubinemia?

What about hemolysis?

Answer 2

Biliary Tract Obstruction =
conjugated hyperb

Hemolysis =
unconjugated hyperb

Question 3

Risk factors for gallstones?

Answer 3

Female - Forty - Fat - Fertile

Also things like rapid weight loss. NA race, meds like octreotide, etc.

Question 4

Give a few ways to determine if pain is biliary pain (like possibly from lithiasis):

Answer 4

• Colic - rapid crescendo and slow decrescendo
• Often post-prandial
• RUQ/epigastrum
• CAn radiate
• Nausea and vomiting can accompy

Question 5

Tx for choledocholithiasis?

Answer 5

Stone in the common bile duct

Tx with an ERCP (endoscopic) to remove stone

Basically you get a wire int he duct and blow up a balloon behind the stone to yank it out. Nice!

Question 6

What is the most sensitive test for seeing stones and microliths that CT or US might miss?

Answer 6

Endoscopic Ultrasound! EUS