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Clinical Med III > Exam 2 - Biliary Disease > Flashcards

Exam 2 - Biliary Disease Flashcards

1
Q

What is the term for stones in the gallbladder?

A

Cholelithiasis

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2
Q

What is the term for inflammation of the gallbladder?

A

Cholecystitis

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3
Q

What is the term for stones in the common bile duct?

A

Choledocholithiasis

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4
Q

What is the term for inflammation of the bile ducts?

A

Cholangitis

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5
Q

What is the term for disruption of bile flow, regardless of cause?

A

Cholestasis

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6
Q

What are some risk factors of cholelithiasis?

A

The Four F’s

  • Female
  • Fluffy
  • Forty
  • Fertile
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7
Q

What is the initial test of choice for cholelithiasis?

A

Ultrasound

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8
Q

What is uncomplicated gallstone disease also known as?

A

Biliary colic

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9
Q

What signs/symptoms are associated with biliary colic?

A
  • Constant and steady RUQ/epigastric pain that may radiate to right shoulder blade
  • Pain lasting at least 30 mins, but less than 5-6 hours
  • Postprandial pain, commonly after eating fatty or greasy foods
  • Nocturnal pain
  • Associated nausea, vomiting, diaphoresis
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10
Q

Is biliary colic associated with a positive or negative Murphy’s sign?

A

Negative Murphy’s sign

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11
Q

What is the preferred initial test in biliary colic?

What is an expected finding?

A

Ultrasound

Gallstones and/or gallbladder sludge expected

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12
Q

What is the recommended management for uncomplicated gallstone disease?

A

Cholecystectomy to prevent recurrent symptoms and complications

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13
Q

What is Functional Gallbladder Disorder characterized by?

A

Characterized by biliary-type pain in the absence of gallstones, sludge, microlithiasis, or microcrystal disease

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14
Q

What is the possible etiology of Functional Gallbladder Disorder?

A

Gallbladder dysmotility

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15
Q

How is Functional Gallbladder Disorder diagnosed?

A

Diagnosis of exclusion

HIDA scan with CCK
- GBEF < 35-40% is considered low and supportive of diagnosis

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16
Q

What is the ultimate management for Functional Gallbladder Disorder?

A

Cholecystectomy

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17
Q

What are some gallstone related complications?

A
  • Acute cholecystitis
  • Choledocholithiasis with or without acute cholangitis
  • Gallstone pancreatitis
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18
Q

What is acute (calculous) cholecystitis?

A

Acute inflammation of the gallbladder which occurs in the setting of cystic duct obstruction

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19
Q

What are signs/symptoms associated with acute (calculous) cholecystitis?

A
  • Biliary pain that progressively worsens
  • Prolonged (> 4-6 hours) of steady and severe RUQ/epigastric pain that may radiate to back or shoulder
  • Fever
  • Tachycardia
  • Ill appearing and may be lying still on table
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20
Q

Is acute (calculous) cholecystitis associated with a positive or negative Murphy’s sign?

A

Positive Murphy’s sign

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21
Q

What will be seen on labs in acute (calculous) cholecystitis?

A
  • Leukocytosis with a left shift
  • May see mild elevation in serum AST/ALT
  • Serum amylase may be elevated
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22
Q

What is the preferred initial study for acute (calculous) cholecystitis diagnosed?

A

Ultrasound

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23
Q

What will likely be seen on ultrasound to support the diagnosis of acute (calculous) cholecystitis?

A
  • Presence of gallstones
  • Gallbladder wall thickening
  • Pericholecystic fluid
  • Positive “sonographic Murphy’s sign”
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24
Q

What is the most common complication of acute (calculous) cholecystitis?

A

Gangrene (older patients, DM, those that delay seeking therapy)

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25
What is the mainstay of treatment for acute (calculous) cholecystitis?
Cholecystectomy
26
What is the management of acute (calculous) cholecystitis?
- Admit to hospital - NPO - IV fluids, pain control, and antibiotics - Cholecystectomy
27
What is acute (acalculous) cholecystitis?
Acute necroinflammatory disease of the gallbladder in the absence of gallstones
28
In what populations is acute (acalculous) cholecystitis most common in?
Hospitalized and critically ill patients
29
What is the treatment for acute (acalculous) cholecystitis?
- Blood cultures - Initiate antibiotics - Cholecystectomy vs. gallbladder drainage
30
When should you suspect acute (acalculous) cholecystitis?
- Critically ill patients with sepsis without clear source or jaundice - Patients with postoperative jaundice
31
What is choledocholithiasis?
Gallstones in the common bile duct
32
What are signs/symptoms associated with uncomplicated choledocholithiasis?
- Biliary-type pain - Jaundice (due to blockage of bile flow) - RUQ or epigastric tenderness - Courvoisier sign (palpable gallbladder) may be seen
33
What lab findings are expected in a patient with uncomplicated choledocholithiasis?
- No leukocytosis on CBC | - Elevated liver tests (AST, ALT)
34
What is the initial imaging study for choledocholithiasis and what will typically be seen?
Ultrasound - Cholelithiasis - CBD stone - CBD dilation (> 6 mm)
35
If ultrasound is still unclear for choledocholithiasis, what could you consider ordering?
MRCP or endoscopic ultrasound
36
What is the management for choledocholithiasis?
- Identify and treat complications (acute cholagitis, acute pancreatitis) - ERCP to remove CBD stone - Cholecystectomy
37
What is the primary cause of acute cholangitis?
- Bacterial infection in a patient with biliary obstruction | - Bacteria typically ascend from duodenum
38
What is Charcot's Triad and what condition is it associated with?
Fever, abdominal pain, jaundice Acute Cholangitis
39
What is Reynolds Pentad and what condition is it associated with?
Fever, abdominal pain, jaundice + mental status change and hypotension Acute Cholangitis
40
What lab findings are typically associated with acute cholangitis?
- Leukocytosis with left shift - Elevated CRP - Evidence of cholestasis (elevated bilirubin, alk. phos. and GGT) - Serum amylase or lipase may be increased 3-4 times normal - Positive blood cultures
41
What imaging studies can be used to diagnose acute cholangitis?
- Ultrasound - CT - MRCP (or EUS)
42
What is the management for acute cholangitis?
- Admit to hospital - Empiric antibiotic coverage for sepsis - Emergent consult with GI/Surgery - ERCP with sphincterotomy and stone extraction (and/or stent insertion) - Follow with cholecystectomy if appropriate
43
What is Primary Biliary Cholangitis (PBC)? In what population is it most common?
Autoimmune destruction of the intrahepatic bile ducts which causes cholestasis. Primarily women 30-65 y/o
44
What is the clinical presentation of PBC?
- May be asymptomatic - Fatigue and pruritis (most common) - RUQ discomfort, skin hyperpigmentation, hepatomegaly, xanthomas, jaundice
45
What lab results are typically associated with PBC?
Liver test (cholestatic pattern) - Elevated Alk. Phos, GGT - ALT/AST may be normal or slightly elevated - Increased serum bilirubin (as disease progresses) Antimitochondrial antibodies (AMA) ANA Hyperlipidemia
46
What is a serologic hallmark of PBC?
Antimitochondrial antibodies (AMA)
47
How is PBC diagnosed?
At least two of the following are present: - Elevated Alk. Phos (1.5 times the upper normal limit) - (+) AMA - Histologic evidence of PBC (liver biopsy if needed) No extrahepatic biliary obstruction or comorbidity affecting the liver
48
What is Primary Sclerosing Cholangitis (PSC)? In what population is there a higher occurrence?
Sclerosing, inflammatory, obliterative process involving the intrahepatic and/or extrahepatic biliary tree. Higher incidence in men.
49
What other disorder is PSC strongly associated with?
IBD (UC > CD)
50
What are signs/symptoms associated with PSC?
- Asymptomatic - Fatigue - Pruritis - Jaundice
51
What lab results are typically associated with PSC?
- Liver tests demonstrate a cholestatic pattern | - Negative AMA
52
What will be seen on MRCP or ERCP to support the diagnosis of PSC?
Multifocal strictures and dilation of intrahepatic and/or extrahepatic bile ducts
53
What are possible complications of PSC?
- End-stage liver disease - Hepatobiliary cancer - Colon cancer (patients with UC)
54
What is Gilbert Syndrome?
- Deficiency in enzyme for glucuronidation of bilirubin in liver (conjugation) - Unconjugated hyperbilirubinemia in the absence of hemolysis
55
What is the clinical presentation associated with Gilbert Syndrome?
- Post-puberty - Mild intermittent episodes of jaundice (dehydration, fasting, menstuation) - Asymptomatic otherwise
56
What is the most common cancer arising in the biliary tract?
Gallbladder cancer
57
What are risk factors for gallbladder cancer?
- Gallstone disease - Porcelain gallbladder - Gallbladder polups - PSC - Chronic infection - Obesity
58
Where does Cholangiocarcinoma arise from?
Arise from epithelial cells of the bile ducts
59
What other disorders is Cholangiocarcinoma associated with?
PSC and choledochal cysts
60
What are signs/symptoms associated with Cholangiocarcinoma?
- Jaundice - Pruritis - Abdominal pain - Weight loss - Fever - Courvoisier sign (rare)
61
What will labs show in Cholangiocarcinoma?
Cholestasis (obstructive pattern)
62
Where does Ampullary Carcinoma arise from?
Arise in the vicinity of the ampulla of Vater
63
What other disorders is Ampullary Carcinoma associated with?
- Familial Adenomatous Polyposis (FAP) | - Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
64
What is the most common presentation associated withAmpullary Carcinoma?
Obstructive jaundice
65
The following is associated with what disorder? - Biliary pain - RUQ pain - (+) Murphy sign - Leukocytosis
Acute cholecystitis
66
The following is associated with what disorder? - More common in women - (+) AMA titer
Primary Biliary Cholangitis (PBC)
67
The following is associated with what disorder? - More common in men - Associated with IBD - Negative AMA titer
Primary Sclerosing Cholangitis (PSC)

Clinical Med III (12 decks)

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