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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
Q

What is the mainstay of treatment for acute (calculous) cholecystitis?

A

Cholecystectomy

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26
Q

What is the management of acute (calculous) cholecystitis?

A
  • Admit to hospital
  • NPO
  • IV fluids, pain control, and antibiotics
  • Cholecystectomy
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27
Q

What is acute (acalculous) cholecystitis?

A

Acute necroinflammatory disease of the gallbladder in the absence of gallstones

28
Q

In what populations is acute (acalculous) cholecystitis most common in?

A

Hospitalized and critically ill patients

29
Q

What is the treatment for acute (acalculous) cholecystitis?

A
  • Blood cultures
  • Initiate antibiotics
  • Cholecystectomy vs. gallbladder drainage
30
Q

When should you suspect acute (acalculous) cholecystitis?

A
  • Critically ill patients with sepsis without clear source or jaundice
  • Patients with postoperative jaundice
31
Q

What is choledocholithiasis?

A

Gallstones in the common bile duct

32
Q

What are signs/symptoms associated with uncomplicated choledocholithiasis?

A
  • Biliary-type pain
  • Jaundice (due to blockage of bile flow)
  • RUQ or epigastric tenderness
  • Courvoisier sign (palpable gallbladder) may be seen
33
Q

What lab findings are expected in a patient with uncomplicated choledocholithiasis?

A
  • No leukocytosis on CBC

- Elevated liver tests (AST, ALT)

34
Q

What is the initial imaging study for choledocholithiasis and what will typically be seen?

A

Ultrasound

  • Cholelithiasis
  • CBD stone
  • CBD dilation (> 6 mm)
35
Q

If ultrasound is still unclear for choledocholithiasis, what could you consider ordering?

A

MRCP or endoscopic ultrasound

36
Q

What is the management for choledocholithiasis?

A
  • Identify and treat complications (acute cholagitis, acute pancreatitis)
  • ERCP to remove CBD stone
  • Cholecystectomy
37
Q

What is the primary cause of acute cholangitis?

A
  • Bacterial infection in a patient with biliary obstruction

- Bacteria typically ascend from duodenum

38
Q

What is Charcot’s Triad and what condition is it associated with?

A

Fever, abdominal pain, jaundice

Acute Cholangitis

39
Q

What is Reynolds Pentad and what condition is it associated with?

A

Fever, abdominal pain, jaundice + mental status change and hypotension

Acute Cholangitis

40
Q

What lab findings are typically associated with acute cholangitis?

A
  • 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
Q

What imaging studies can be used to diagnose acute cholangitis?

A
  • Ultrasound
  • CT
  • MRCP (or EUS)
42
Q

What is the management for acute cholangitis?

A
  • 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
Q

What is Primary Biliary Cholangitis (PBC)?

In what population is it most common?

A

Autoimmune destruction of the intrahepatic bile ducts which causes cholestasis.

Primarily women 30-65 y/o

44
Q

What is the clinical presentation of PBC?

A
  • May be asymptomatic
  • Fatigue and pruritis (most common)
  • RUQ discomfort, skin hyperpigmentation, hepatomegaly, xanthomas, jaundice
45
Q

What lab results are typically associated with PBC?

A

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
Q

What is a serologic hallmark of PBC?

A

Antimitochondrial antibodies (AMA)

47
Q

How is PBC diagnosed?

A

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
Q

What is Primary Sclerosing Cholangitis (PSC)?

In what population is there a higher occurrence?

A

Sclerosing, inflammatory, obliterative process involving the intrahepatic and/or extrahepatic biliary tree.

Higher incidence in men.

49
Q

What other disorder is PSC strongly associated with?

A

IBD (UC > CD)

50
Q

What are signs/symptoms associated with PSC?

A
  • Asymptomatic
  • Fatigue
  • Pruritis
  • Jaundice
51
Q

What lab results are typically associated with PSC?

A
  • Liver tests demonstrate a cholestatic pattern

- Negative AMA

52
Q

What will be seen on MRCP or ERCP to support the diagnosis of PSC?

A

Multifocal strictures and dilation of intrahepatic and/or extrahepatic bile ducts

53
Q

What are possible complications of PSC?

A
  • End-stage liver disease
  • Hepatobiliary cancer
  • Colon cancer (patients with UC)
54
Q

What is Gilbert Syndrome?

A
  • Deficiency in enzyme for glucuronidation of bilirubin in liver (conjugation)
  • Unconjugated hyperbilirubinemia in the absence of hemolysis
55
Q

What is the clinical presentation associated with Gilbert Syndrome?

A
  • Post-puberty
  • Mild intermittent episodes of jaundice (dehydration, fasting, menstuation)
  • Asymptomatic otherwise
56
Q

What is the most common cancer arising in the biliary tract?

A

Gallbladder cancer

57
Q

What are risk factors for gallbladder cancer?

A
  • Gallstone disease
  • Porcelain gallbladder
  • Gallbladder polups
  • PSC
  • Chronic infection
  • Obesity
58
Q

Where does Cholangiocarcinoma arise from?

A

Arise from epithelial cells of the bile ducts

59
Q

What other disorders is Cholangiocarcinoma associated with?

A

PSC and choledochal cysts

60
Q

What are signs/symptoms associated with Cholangiocarcinoma?

A
  • Jaundice
  • Pruritis
  • Abdominal pain
  • Weight loss
  • Fever
  • Courvoisier sign (rare)
61
Q

What will labs show in Cholangiocarcinoma?

A

Cholestasis (obstructive pattern)

62
Q

Where does Ampullary Carcinoma arise from?

A

Arise in the vicinity of the ampulla of Vater

63
Q

What other disorders is Ampullary Carcinoma associated with?

A
  • Familial Adenomatous Polyposis (FAP)

- Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

64
Q

What is the most common presentation associated withAmpullary Carcinoma?

A

Obstructive jaundice

65
Q

The following is associated with what disorder?

  • Biliary pain
  • RUQ pain
  • (+) Murphy sign
  • Leukocytosis
A

Acute cholecystitis

66
Q

The following is associated with what disorder?

  • More common in women
  • (+) AMA titer
A

Primary Biliary Cholangitis (PBC)

67
Q

The following is associated with what disorder?

  • More common in men
  • Associated with IBD
  • Negative AMA titer
A

Primary Sclerosing Cholangitis (PSC)

Clinical Med III (12 decks)

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