Exam 2 BILIARY DZ Flashcards
Cholelithiasis is?
Risk factors?
Stones in gallbladder
4 F's: Female Fluffy Forty Fertile (preggo or E2 birthcontrol pills)
Native Americans
Cholelithiasis stone types? (2)
Cholesterol (80%)
Pigment (Ca2+, bilirubin, proteins)
Cholelithiasis diagnostics?
US = TOC (shows stones, wall thick, fluid)
Cholelithiasis management?
Asympt: none
Sympt: Cholecystectomy (CCY) = gallbladder removal
Cholelithiasis complications? (3)
stones,
inflammed GB and/or ducts,
disrupted bile flow
Biliary Colic is?
Caused by?
TEMPORARY cystic duct obstruction,
Often initial presentation of GB dz
U gallstone
Biliary Colic pathophys?
Pressure ↑ in GB causing pain
GB relaxes -> obstruction relieved
NO assoc’d inflammation
Biliary Colic presentation? (6)
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
Biliary Colic labs? (4)
CBC
LFT
Amylase,
Lipase
All are normal
Biliary Colic imaging?
Tx?
US = gallstone or sludge
Prophylactic CCY
Biliary Dyskinesia is?
Presentation?
Motility GB disorder
biliary colic w/ negative US
Biliary Dyskinesia additional testing?
HIDA w/ CCK and Ejct Fraction
Abnormal motility = EF <35%
DO NOT USE CCK if gallstones present
Biliary Dyskinesia tx?
CCY if:
1) typical biliary sxs
2) HIDA EF < 35%
3) Everything else r/o
Acute Cholecyctitis is?
C caused by?
Mortality?
Acute inflamm of GB 2° to obstruction of cystic duct
Cholesterol stones
3%
Acute Cholecyctitis presentation? (9)
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
Acute Cholecyctitis complications? (5)
GB Gangrene (esp immuno, old, delayed tx) Perforation Peritonitis Cholecystoenteric fistula Gallstone ileus
Acute Cholecyctitis labs? (4)
CBC = ↑ WBC w/ left shift
LFT = N or mild ↑ AST/ALT, alk phos, bilirubin
UA = ↑ urobilinogen
Pancreatic Enz = mild amylase ↑
Acute Cholecyctitis: If significant ↑ of AST/ALT, alk phos, bilirubin, indicated what?
Common Bile Duct obstruction
Acute Cholecyctitis imaging?
US = + gallstones, thick wall, fluid, + Murphy
HIDA = confirmation if unsure US
Acute Cholecyctitis tx? (6)
Admit all Pain mgmt (ketorolac, morphine, meperidine) NPO IV fluids w/ e- IV ABX Early CCY
Chronic Cholecystitis is?
Chronic inflamm of GB
a/w mechanical irritation from gallstone or repeat acute cholecyctitis
Acalculous Cholcystitis U seen in?
a/w?
Critically ill pts
a/w stasis/ischemia
Acalculous Cholcystitis presentation?
Same as acute cholsystitis EXCEPT
No stones,
P jaundice
Acalculous Cholcystitis diagnostics?
CBC
LFT
US
Acalculous Cholcystitis tx?
C complication?
Prognosis?
Prompt CCY or Cholcystostomy
2° GB infection
Very poor
Choledocholithiasis is?
Stone in CBD
Choledocholithiasis presentation? (7)
Biliary type pain RUQ or epigastric N/V (P) abd tenderness JAUNDICE, icterus Tea-colored urine Light-colored stool Vitals normal
Choledocholithiasis labs?
CBC = no leukocytosis
LFT = ↑ conj bilirubin, ↑ alk phos
Pancreatic Enz = N amylase/lipse
Choledocholithiasis imaging?
RUQ US = CBD stone and dilation, gallstones
MRCP if US unclear
Choledocholithiasis tx?
Stone removal
Prophy ABX
ERCP = therapeutic test (removes stones, place stents, sphincterotomy)
Then CCY
Ascending Cholangitis is?
a/w?
Infection of biliary tract
U CBD
a/w biliary obstruction (CBD stone) =
“Pus under pressure”
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
Ascending Cholangitis labs?
CBC = ↑ leukocytosis LFT = ↑conj bili, ↑ alk phos Panc Enz = N or mild ↑ UA = ↑ bilirub Blood cx
Ascending Cholangitis imaging?
Only if dx still in question:
US
MRCP = CBD stone/dilation
Ascending Cholangitis tx?
ADMIT NPO IV fluids ABX: metro + ceftri or cipro ERCP w/ stone remove and sphincterotomy Then CCY
Primary Biliary Cirrhosis is?
Autoimmune destruction of small intrahepatic bile ducts causing cholestasis ->
cirrh and liver fail
Primary Biliary Cirrhosis presentation? (8)
FATIGUE PRURITIS Arthritis RUQ pain CREST sxs Hyperpigmentation Xanthoma Heaptomegaly
CREST sxs are?
Calcium deposits Raynaud's Esophageal dysmotility Sclerodactyly (tight/hard skin on digits) Telangiectasias
Primary Biliary Cirrhosis labs? (5)
LFT = ↑ alk phos, ↑ GTT and 5NT AMA (anti-mitochondrial antibodies) = + (95%) ANA (antinuclear antibody) = + (70%) IgM Hyperlipidemia
Primary Biliary Cirrhosis diagnostics?
Liver bx = florid bile duct lesion
Primary Biliary Cirrhosis tx? (2)
Urso Rx (dissolves stones) DEXA
Primary Sclerosing Cholangitis is?
C in what group?
Inflamm/fibrosis of med and large intra/extra hepatic ducts ->
cirrhosis
Males, U w/ IBD
Primary Sclerosing Cholangitis presentation? (6)
Asympt FATIGUE PRURITIS Jaundice Steatorrhea Osteoporosis
Primary Sclerosing Cholangitis complications? (4)
Biliary stricture
CholangioCA
Gb CA
Colon CA
Primary Sclerosing Cholangitis labs? (5)
LFT = cholestatic P-ANCA ASMA ANA IgM
Primary Sclerosing Cholangitis imaging? (2)
ERCP = diag and tx MRCP = multifocal stricturing w/ intra and extrahepatic ductal dilation
Bx U not diagnostic
Primary Sclerosing Cholangitis? (3)
Monitor bone density and for complications
ERCP for strictures
Liver transplant
Gilbert’s Synd is?
Deficiency in liver enz needed for bilirubin conjugation
Gilbert’s Synd suspected when?
unconj hyperbilirubinemia w/o hemolysis:
Rest of LFT = N
CBC, blood smear and reticulocyte count = N
GB CA?
Risk factors?
> 50% of biliary tract CAs
Cholelithiasis
GB polyps >1cm
Salmonella
GB CA presentation?
Indistinguishable from cholelithiasis clinically
Cholangiocarcinoma is?
a/w?
AdenoCA of bile ducts
a/w Primary Sclerosing Cholangitis and choledochal cysts
Cholangiocarcinoma presentation? (4)
Jaundice
Vague up abd pain
Anorexia/Wgt loss
Pruritis
Cholangiocarcinoma labs? (3)
↑ conj bilirubin
↑ alk phos
↑ Carb Antigen 19-9
Ampullary CA a/w? (2)
Familial Adenomatous Polyposis,
Hereditary Non-Polyposis Colon CA
Ampullary CA presentation? (3)
OBSTRUCTIVE JAUNDICE
Occult GI bleeding w/ microcytic anemia
Abd pain
