DSA 3: Approach to Hepatobiliary Patient (Biliary, Gallbladder) Flashcards
What sign is present when deep inspiration or cough during palpation of the RUQ produces increased pain or inspiratory arrest?
Murphy’s sign
What are the two major types of choleltihiasis?
Which is more common?
1) Cholesterol stones are more common
2) Calcium bilirubinate (pigment stones)
What is biliary colic?
Where can it radiate?
1) A severe steady ache in the RUQ or epigastrium
2) Right scapula
What is the best diagnostic test for cholelithiasis?
What can be seen?
1) US
2) Stones cast acoustic shadow
What are the risk factors for gallstones?
1) Family history
2) Fair
3) Fat
4) Female
5) Fertile
6) Forty
90 percent of the time what is the problem causing acute cholecystitis?
Calculous (Gallstones)
What often precipitates acute cholecystitis?
What is a major symptom of acute cholecystitis?
1) Large fatty meal
2) Tea-colored urine or acholic stools
What labs indicate acute cholecystitis?
1) Leukocytosis
2) Bilirubinemia
3) Alkaline phosphatase (ALP) and GGT levels increased
What is the imaging used to diagnose acute cholecystitis?
RUQ abdominal US
What complications can arise from acute cholecystitis?
1) Gangrene of the gallbladder
2) Emphysematous cholecystitis (secondary infection with a gas-forming organism)
Stones in the common bile duct leads to?
Choledocholithiasis
What can choledocholithiasis lead to?
Ascending Cholangitis
What is a diagnostic and therapeutic tool for choledocholithiasis and ascending cholangitis?
ERCP
How does ascending cholangitis present?
1) Charcot triad: RUQ pain, fever, and jaundice
2) Reynold pentad: Charcot triad along with altered mental status and hypotension
What should be done if a patient presents with Reynold pentad?
Endoscopic emergency
Ascending cholangitis has positive blood cultures for?
1) E. Coli
2) Klebsiella
3) Enterococcus
What should be done before Endoscopic Retrograde Cholangiopancreatography (ERCP)?
What is a potential complication of this procedure?
1) Measure INR and Pregnancy test
2) Acute pancreatitis
What are the treatment options for acute cholecystitis?
1) Antibiotics
2) Laparoscopic cholecystectomy
What are the treatment options for choledocholithiasis?
1) ERCP
2) Laparoscopic cholecystectomy
What are the treatment options for cholangitis?
Urgent ERCP to remove stones
What should be done for primary sclerosing cholangitis that is severe and progresses to an end stage cirrhosis?
Liver transplant
What diagnostic tool is used to determine biliary dyskinesia as the cause?
HIDA scan
What is found with HIDA scan that points towards biliary dyskinesia?
An abnormal ejection fraction (less than 35-38%)
What complications can arise from chronic cholecystitis?
1) Porcelain gallbladder
2) Increased risk of gallbladder cancer
What does primary sclerosing cholangitis look like on MRCP or ERCP?
What does liver biopsy show in primary sclerosing cholangitis?
1) Beads on a string
2) Onion skinning
What population is affected most with primary sclerosing cholangitis?
Males 20-50 yo
What is primary sclerosing cholangitis associated with?
IBD (mostly UC)
How does primary sclerosing cholangitis present on H&P?
Pruritus and jaundice
What are complications associated with primary sclerosing cholangitis?
1) Increased risk of cholangiocarcinoma
2) Increased risk of colon carcinoma due to UC
