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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?

25
Acalculous Cholcystitis tx? C complication? Prognosis?
Prompt CCY or Cholcystostomy 2° GB infection Very poor
26
Choledocholithiasis is?
Stone in CBD
27
Choledocholithiasis presentation? (7)
``` Biliary type pain RUQ or epigastric N/V (P) abd tenderness JAUNDICE, icterus Tea-colored urine Light-colored stool Vitals normal ```
28
Choledocholithiasis labs?
CBC = no leukocytosis LFT = ↑ conj bilirubin, ↑ alk phos Pancreatic Enz = N amylase/lipse
29
Choledocholithiasis imaging?
RUQ US = CBD stone and dilation, gallstones MRCP if US unclear
30
Choledocholithiasis tx?
Stone removal Prophy ABX ERCP = therapeutic test (removes stones, place stents, sphincterotomy) Then CCY
31
Ascending Cholangitis is? a/w?
Infection of biliary tract U CBD a/w biliary obstruction (CBD stone) = "Pus under pressure"
32
Ascending Cholangitis presentation? (9)
``` RUQ/epigastric pain ABD tenderness/guarding HX of biliary colic or dz Looks ill JAUNDICE, icterus FEVER/CHILLS TACHY HYPOTN Mental status ∆s ```
33
Ascending Cholangitis labs?
``` CBC = ↑ leukocytosis LFT = ↑conj bili, ↑ alk phos Panc Enz = N or mild ↑ UA = ↑ bilirub Blood cx ```
34
Ascending Cholangitis imaging?
Only if dx still in question: US MRCP = CBD stone/dilation
35
Ascending Cholangitis tx?
``` ADMIT NPO IV fluids ABX: metro + ceftri or cipro ERCP w/ stone remove and sphincterotomy Then CCY ```
36
Primary Biliary Cirrhosis is?
Autoimmune destruction of small intrahepatic bile ducts causing cholestasis -> cirrh and liver fail
37
Primary Biliary Cirrhosis presentation? (8)
``` FATIGUE PRURITIS Arthritis RUQ pain CREST sxs Hyperpigmentation Xanthoma Heaptomegaly ```
38
CREST sxs are?
``` Calcium deposits Raynaud's Esophageal dysmotility Sclerodactyly (tight/hard skin on digits) Telangiectasias ```
39
Primary Biliary Cirrhosis labs? (5)
``` LFT = ↑ alk phos, ↑ GTT and 5NT AMA (anti-mitochondrial antibodies) = + (95%) ANA (antinuclear antibody) = + (70%) IgM Hyperlipidemia ```
40
Primary Biliary Cirrhosis diagnostics?
Liver bx = florid bile duct lesion
41
Primary Biliary Cirrhosis tx? (2)
``` Urso Rx (dissolves stones) DEXA ```
42
Primary Sclerosing Cholangitis is? C in what group?
Inflamm/fibrosis of med and large intra/extra hepatic ducts -> cirrhosis Males, U w/ IBD
43
Primary Sclerosing Cholangitis presentation? (6)
``` Asympt FATIGUE PRURITIS Jaundice Steatorrhea Osteoporosis ```
44
Primary Sclerosing Cholangitis complications? (4)
Biliary stricture CholangioCA Gb CA Colon CA
45
Primary Sclerosing Cholangitis labs? (5)
``` LFT = cholestatic P-ANCA ASMA ANA IgM ```
46
Primary Sclerosing Cholangitis imaging? (2)
``` ERCP = diag and tx MRCP = multifocal stricturing w/ intra and extrahepatic ductal dilation ``` Bx U not diagnostic
47
Primary Sclerosing Cholangitis? (3)
Monitor bone density and for complications ERCP for strictures Liver transplant
48
Gilbert's Synd is?
Deficiency in liver enz needed for bilirubin conjugation
49
Gilbert's Synd suspected when?
unconj hyperbilirubinemia w/o hemolysis: Rest of LFT = N CBC, blood smear and reticulocyte count = N
50
GB CA? Risk factors?
>50% of biliary tract CAs Cholelithiasis GB polyps >1cm Salmonella
51
GB CA presentation?
Indistinguishable from cholelithiasis clinically
52
Cholangiocarcinoma is? a/w?
AdenoCA of bile ducts a/w Primary Sclerosing Cholangitis and choledochal cysts
53
Cholangiocarcinoma presentation? (4)
Jaundice Vague up abd pain Anorexia/Wgt loss Pruritis
54
Cholangiocarcinoma labs? (3)
↑ conj bilirubin ↑ alk phos ↑ Carb Antigen 19-9
55
Ampullary CA a/w? (2)
Familial Adenomatous Polyposis, | Hereditary Non-Polyposis Colon CA
56
Ampullary CA presentation? (3)
OBSTRUCTIVE JAUNDICE Occult GI bleeding w/ microcytic anemia Abd pain

Q4 Clin Med III (GI) (32 decks)

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