Diseases of the Biliary Tree Flashcards
What is cholelithiasis?
Gallbladder stones.
What is choledocolithiasis?
Bile duct stones.
What is biliary colic?
(1) Rapid onset, severe, steady RUQ or epigastric pain.
(2) Radiation to the R shoulder or R scapula.
(3) Duration is 15 min to several hours.
(4) Not relieved by position change, antacids, or flatus.
(5) Associated with fatty food intolerance.
What is the clinical presentation of acute cholecystitis?
(1) RUQ pain
(2) fever
(3) leukocytosis
What are complications of acute cholecystitis?
(1) gangrene
(2) perforation
(3) sepsis
What is the pathophysiology of acute cholecystitis?
(1) Obstruction of the cystic duct.
(2) Irritant factor leads to inflammatory mediator response and the propagation of inflammation in the gallbladder.
How is acute cholecystitis treated?
Cholecystectomy.
What is the pathogenesis of bacterial cholangitis?
(1) Bile duct obstruction leads to stasis, raising intrabiliary pressure.
(2) This promotes migration and colonization of bacteria from the portal circulation into the biliary tract.
What is Charcot’s triad?
(1) fever
(2) RUQ pain
(3) jaundice
What is the clinical presentation of bacterial cholangitis?
(1) Charcot’s triad
(2) confusion
(3) hypotension
How is bacterial cholangitis treated?
(1) antibiotics
2) duct clearance (often using ERCP
What is the surgical procedure for the removal of stones from the bile duct?
An ERCP is performed, followed by an endoscopic sphincterotomy, cutting the sphincter of Oddi. A catheter with a basket or balloon tip is inserted into the bile duct to retrieve the stones.
What factors increase the risk of gallstone pancreatitis in a patient with cholelithiasis?
(1) wide cystic duct
(2) multiple, small gallstones
What risk factors for biliary sludge?
(1) pregnancy
(2) TPN
(3) starvation
(4) weight loss
How are patients with asymptomatic common bile duct stones managed?
Removal of stones, due to the risk of bacterial cholangitis and gallstone pancreatitis.
How are patients with asymptomatic gallbladder stones managed?
Monitor.
How are biliary strictures treated?
Insertion of a fixed-diameter plastic stent or self-expanding metallic stent into the bile duct. Balloon dilatation can also be performed in some cases.
What is the primary complication with fixed-diameter plastic stents?
Occlusion with:
(1) bacteria
(2) bacterial glycocalyx
(3) calcium bilirubinate
(4) calcium palmitate
(5) insoluble dietary fiber
What are causes of biliary strictures?
(1) mass effect from tumor
(2) bile duct injury (trauma, post-operative, post-liver transplant)
(3) chronic pancreatitis
(4) PSC
What is the pathogenesis of PSC?
Unknown.
What test is performed in order to diagnose PSC?
Cholangiogram.
How does PSC appear on cholangiogram?
Multifocal stricturing of varying lengths and dilation of intrahepatic and/or extrahepatic bile ducts.
How is PSC treated?
(1) ursodiol and antimicrobials
(2) stenting or dilation of strictures
(3) liver transplant
