extrahepatic billiary diseases Flashcards

1
Q

bile composition

A

pigment- bilirubin

bile acids- cholesterol

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2
Q

Gallstone formation factors

A

Cholesterol oversaturation
Mucin hypersecretion by the GB mucosa
Bile stasis (motility disorders)

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3
Q

Gallstone Risk Factors (5)

A
Fair
Fat
Fertile
Female
Forty
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4
Q

Gallstones Types

A

Cholesterol stones (85%)

Pigment stones (15%) :

Black- excess bilirubin enters the bile and polymerizes into calcium bilirubinate (chronic hemolysis)

Brown - bacteria secretion of beta glucuronidase and phospholipase

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5
Q

locations of gall stones

A
right hepatic duct
gall bladder
cytic duct
common bile duct
spincher of oddi
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6
Q

Cholelithiasis

A

Presence of stones
Asymptomatic vs. Symptomatic
Asymptomatic gallstones generally do not need to be treated

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7
Q

Biliary Colic

A

Intermittent obstruction of the cystic duct, no inflammation of GB

Severe epigastric/ RUQ pain - over 15 min and remaining constant up to 3h

Normal examination (unless in an attack)

Lab tests usually normal

US, EUS

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8
Q

Acute Calculous Cholecystitis

A

Impacted stone in the cystic duct

Fever, Murphy’s sign, palpable GB

Leucocytosis, normal or mild elevation of bilirubin

50% resolve spontaneously in 7-10 days

US – gallbladder wall thickening, EUS, CT

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9
Q

Choledocholithiasis

A

Intermittent obstruction of CBD

jaundice with pain

Elevated bilirubin
transient spike in Transaminases / Amylase

US, EUS, CT

treatment- ERCP - Endoscopic Retrograde CholangioPancreatography

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10
Q

ascending cholangitis

A

Impacted stone in CBD causing bile stasis

Bacterial superinfection

Charcot’s triad 70%

confusion, hypotension, RUQ tenderness, jaundice (80%)

Elevated WBC, BIL

treatment: ERCP

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11
Q

Acute biliary pancreatitis

A

Pancreatic duct obstruction or chemical inflammation

Signs - Variable – None to Sepsis

Bloods – U&E, WBC, LFT, Amylase, CRP
US
MRCP
CT Pancreas

treatment- ERCP

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12
Q

Gallstone ileus

A

small bowel Obstruction by a large gallstone

at the terminal ileum/acending colon

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13
Q

Acute Acalculous Cholecystitis

A

inflamed gallbladder in the absence of an obstructed cystic or common bile duct

occurs in the setting of a critically ill patient

ischemic basis

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14
Q

Biliary Tract Cysts

A

Choledochal cysts (risk of malignancy)

90% diagnosed before age 30

Surgery

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15
Q

Biliary Tract Tumors

A

Cholangiocarcinoma
slow
to infiltrate locally and metastasize late
90% adenocarcinoma

Cancer of the Gall Bladder

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16
Q

Cholangiocarcinoma locations

A

60-70% at the bifurcation of hepatic ducts (klatskin)
20-30% - in the distal CBD
5-10% - arise within the liver (peripheral)

17
Q

Cholangiocarcinoma treatment

A

Surgical Removal – many patients have tumors that are not resectable

palliative
Stent
Chemotherapy +/- Radiation Therapy

18
Q

Gall Bladder Cancer treatment

A

If negative for metastasis:
Radical cholecystectomy with nodal dissection, central hepatectomy, +- bile duct excision

Followed by Chemo/Radiation

5 year survival = 60%