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Q4 Clin Med III (GI) > Exam 2 BILIARY DZ > Flashcards

Exam 2 BILIARY DZ Flashcards

1
Q

Cholelithiasis is?

Risk factors?

A

Stones in gallbladder

4 F's:
Female
Fluffy
Forty
Fertile (preggo or E2 birthcontrol pills)

Native Americans

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2
Q

Cholelithiasis stone types? (2)

A

Cholesterol (80%)

Pigment (Ca2+, bilirubin, proteins)

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3
Q

Cholelithiasis diagnostics?

A

US = TOC (shows stones, wall thick, fluid)

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4
Q

Cholelithiasis management?

A

Asympt: none

Sympt: Cholecystectomy (CCY) = gallbladder removal

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5
Q

Cholelithiasis complications? (3)

A

stones,
inflammed GB and/or ducts,
disrupted bile flow

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6
Q

Biliary Colic is?

Caused by?

A

TEMPORARY cystic duct obstruction,
Often initial presentation of GB dz

U gallstone

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7
Q

Biliary Colic pathophys?

A

Pressure ↑ in GB causing pain
GB relaxes -> obstruction relieved
NO assoc’d inflammation

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8
Q

Biliary Colic presentation? (6)

A

Constant dull RUQ pain w/ radiation to R shoulder blade (lasts <6hrs)

Triggered by fatty meal

N/V
Diaphoresis
Normal vitals
No rebound or Murphy

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9
Q

Biliary Colic labs? (4)

A

CBC
LFT
Amylase,
Lipase

All are normal

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10
Q

Biliary Colic imaging?

Tx?

A

US = gallstone or sludge

Prophylactic CCY

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11
Q

Biliary Dyskinesia is?

Presentation?

A

Motility GB disorder

biliary colic w/ negative US

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12
Q

Biliary Dyskinesia additional testing?

A

HIDA w/ CCK and Ejct Fraction

Abnormal motility = EF <35%

DO NOT USE CCK if gallstones present

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13
Q

Biliary Dyskinesia tx?

A

CCY if:

1) typical biliary sxs
2) HIDA EF < 35%
3) Everything else r/o

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14
Q

Acute Cholecyctitis is?

C caused by?

Mortality?

A

Acute inflamm of GB 2° to obstruction of cystic duct

Cholesterol stones

3%

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15
Q

Acute Cholecyctitis presentation? (9)

A 
Steady, severe RUQ pain (Lasts > 6hrs)
\+/- radiation to R shoulder/flank
N/V, diaphoresis
Fever/Tachy
No jaundice
Tender abdomen
Positive Murphy's
PRIOR HX of biliary colic
Triggered by fatty meal
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16
Q

Acute Cholecyctitis complications? (5)

A 
GB Gangrene (esp immuno, old, delayed tx)
Perforation
Peritonitis
Cholecystoenteric fistula
Gallstone ileus
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17
Q

Acute Cholecyctitis labs? (4)

A

CBC = ↑ WBC w/ left shift
LFT = N or mild ↑ AST/ALT, alk phos, bilirubin
UA = ↑ urobilinogen
Pancreatic Enz = mild amylase ↑

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18
Q

Acute Cholecyctitis: If significant ↑ of AST/ALT, alk phos, bilirubin, indicated what?

A

Common Bile Duct obstruction

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19
Q

Acute Cholecyctitis imaging?

A

US = + gallstones, thick wall, fluid, + Murphy

HIDA = confirmation if unsure US

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20
Q

Acute Cholecyctitis tx? (6)

A 
Admit all
Pain mgmt (ketorolac, morphine, meperidine)
NPO
IV fluids w/ e-
IV ABX
Early CCY
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21
Q

Chronic Cholecystitis is?

A

Chronic inflamm of GB

a/w mechanical irritation from gallstone or repeat acute cholecyctitis

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22
Q

Acalculous Cholcystitis U seen in?

a/w?

A

Critically ill pts

a/w stasis/ischemia

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23
Q

Acalculous Cholcystitis presentation?

A

Same as acute cholsystitis EXCEPT
No stones,
P jaundice

24
Q

Acalculous Cholcystitis diagnostics?

A

CBC
LFT

US

25
Q

Acalculous Cholcystitis tx?

C complication?

Prognosis?

A

Prompt CCY or Cholcystostomy

2° GB infection

Very poor

26
Q

Choledocholithiasis is?

A

Stone in CBD

27
Q

Choledocholithiasis presentation? (7)

A 
Biliary type pain RUQ or epigastric
N/V
(P) abd tenderness
JAUNDICE, icterus
Tea-colored urine
Light-colored stool
Vitals normal
28
Q

Choledocholithiasis labs?

A

CBC = no leukocytosis
LFT = ↑ conj bilirubin, ↑ alk phos
Pancreatic Enz = N amylase/lipse

29
Q

Choledocholithiasis imaging?

A

RUQ US = CBD stone and dilation, gallstones

MRCP if US unclear

30
Q

Choledocholithiasis tx?

A

Stone removal
Prophy ABX

ERCP = therapeutic test (removes stones, place stents, sphincterotomy)
Then CCY

31
Q

Ascending Cholangitis is?

a/w?

A

Infection of biliary tract
U CBD
a/w biliary obstruction (CBD stone) =
“Pus under pressure”

32
Q

Ascending Cholangitis presentation? (9)

A 
RUQ/epigastric pain
ABD tenderness/guarding
HX of biliary colic or dz
Looks ill
JAUNDICE, icterus
FEVER/CHILLS
TACHY
HYPOTN
Mental status ∆s
33
Q

Ascending Cholangitis labs?

A 
CBC = ↑ leukocytosis
LFT = ↑conj bili, ↑ alk phos
Panc Enz = N or mild ↑
UA = ↑ bilirub
Blood cx
34
Q

Ascending Cholangitis imaging?

A

Only if dx still in question:
US
MRCP = CBD stone/dilation

35
Q

Ascending Cholangitis tx?

A 
ADMIT
NPO
IV fluids
ABX: metro + ceftri or cipro
ERCP w/ stone remove and sphincterotomy
Then CCY
36
Q

Primary Biliary Cirrhosis is?

A

Autoimmune destruction of small intrahepatic bile ducts causing cholestasis ->
cirrh and liver fail

37
Q

Primary Biliary Cirrhosis presentation? (8)

A 
FATIGUE
PRURITIS
Arthritis
RUQ pain
CREST sxs
Hyperpigmentation
Xanthoma
Heaptomegaly
38
Q

CREST sxs are?

A 
Calcium deposits
Raynaud's
Esophageal dysmotility
Sclerodactyly (tight/hard skin on digits)
Telangiectasias
39
Q

Primary Biliary Cirrhosis labs? (5)

A 
LFT = ↑ alk phos, ↑ GTT and 5NT
AMA (anti-mitochondrial antibodies) = + (95%)
ANA (antinuclear antibody) = + (70%)
IgM
Hyperlipidemia
40
Q

Primary Biliary Cirrhosis diagnostics?

A

Liver bx = florid bile duct lesion

41
Q

Primary Biliary Cirrhosis tx? (2)

A 
Urso Rx (dissolves stones)
DEXA
42
Q

Primary Sclerosing Cholangitis is?

C in what group?

A

Inflamm/fibrosis of med and large intra/extra hepatic ducts ->
cirrhosis

Males, U w/ IBD

43
Q

Primary Sclerosing Cholangitis presentation? (6)

A 
Asympt
FATIGUE
PRURITIS
Jaundice
Steatorrhea
Osteoporosis
44
Q

Primary Sclerosing Cholangitis complications? (4)

A

Biliary stricture
CholangioCA
Gb CA
Colon CA

45
Q

Primary Sclerosing Cholangitis labs? (5)

A 
LFT = cholestatic
P-ANCA
ASMA
ANA
IgM
46
Q

Primary Sclerosing Cholangitis imaging? (2)

A 
ERCP = diag and tx
MRCP = multifocal stricturing w/ intra and extrahepatic ductal dilation

Bx U not diagnostic

47
Q

Primary Sclerosing Cholangitis? (3)

A

Monitor bone density and for complications
ERCP for strictures
Liver transplant

48
Q

Gilbert’s Synd is?

A

Deficiency in liver enz needed for bilirubin conjugation

49
Q

Gilbert’s Synd suspected when?

A

unconj hyperbilirubinemia w/o hemolysis:

Rest of LFT = N
CBC, blood smear and reticulocyte count = N

50
Q

GB CA?

Risk factors?

A

> 50% of biliary tract CAs

Cholelithiasis
GB polyps >1cm
Salmonella

51
Q

GB CA presentation?

A

Indistinguishable from cholelithiasis clinically

52
Q

Cholangiocarcinoma is?

a/w?

A

AdenoCA of bile ducts

a/w Primary Sclerosing Cholangitis and choledochal cysts

53
Q

Cholangiocarcinoma presentation? (4)

A

Jaundice
Vague up abd pain
Anorexia/Wgt loss
Pruritis

54
Q

Cholangiocarcinoma labs? (3)

A

↑ conj bilirubin
↑ alk phos
↑ Carb Antigen 19-9

55
Q

Ampullary CA a/w? (2)

A

Familial Adenomatous Polyposis,

Hereditary Non-Polyposis Colon CA

56
Q

Ampullary CA presentation? (3)

A

OBSTRUCTIVE JAUNDICE
Occult GI bleeding w/ microcytic anemia
Abd pain

Q4 Clin Med III (GI) (32 decks)

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