G/I 2 Flashcards
Choledocholithiasis – best initial study? Most accurate study?
1st = RUQ ultrasound
Most accurate = ERCP
PTC is alternative to ERCP
Which is more sensitive to liver damage – ALT or AST?
ALT
ALT & AST usually have similar increase except in what condition?
Alcoholic hepatitis – AST > ALT
What to consider if Alk-phos is elevated but GGT is not?
Pregnancy or bone disease
Cholelithiasis – what is it?
Stones in the gall bladder
e.g. gallstones
Cholelithiasis – what causes black pigment stones?
other types of stones are cholesterol or mixed
Usually ass’d w/:
- Hemolysis (sickle cell, thalassemia, hereditary spherocytosis, artificial heart valves)
or
- Alcoholic cirrhosis
What is Boas’ sign?
Referred right subscapular pain from biliary colic (cholelithiasis/cholecystitis)
What to do if LFTs reveal cholestasis (inc’d Alk-phos or GGT)?
Abdominal or RUQ U/S
- high sensitivity & specificity (> 95%) for stones
Signs of biliary obstruction?
- Elevated alk phos & GGT
- Elevated conjugated bilirubin
- Jaundice
- Pruritis
- Clay-colored stools
- Dark urine
What is Acute Cholecystitis?
Acute inflammation of the gallbladder wall 2/2 obstruction of the cystic duct
NOT from infection
Acute Cholecystitis – clinical features?
Pain in RUQ or epigastrum, sometimes radiates to right shoulder or scapula
- Nausea, vomiting, anorexia
- RUQ tenderness, rebound tenderness in RUQ
- Murphy’s sign is pathognomonic — inspiratory arrest during deep palpation of RUQ (usually not present)
- Hypoactive bowel sounds
- Low-grade fever, leukocytosis
Acute cholecystitis – Dx test?
RUQ ultrasound
- if inconclusive, use HIDA scan & if this is normal, acute cholecystitis can be ruled out
What is meant by a positive HIDA?
Means that the gallbladder is not visualized 4 hours after injection, confirming Dx of acute cholecystitis
** HIDA = Radionuclide scan (HepatoIminoDiacetic Acid) **
Acute Cholecystitis – Tx?
Laparoscopic Surgery, or open surgery if there’s perforation of gallbladder
- If asymptomatic, can manage w/:
Fluids, make NPO, IV antibiotics, analgesics, & correction of electrolyte abnormalities
Choledocholithiasis – Tx?
- ERCP w/ sphincterotomy & stone extraction w/ stent placement (successful in 90% of patients)
- Laparoscopic choledocholithotomy (in select cases)
What is Cholangitis?
Infection of biliary tract secondary to obstruction, which leads to biliary stasis & bacterial overgrowth
– requires emergent Tx!
Cholangitis – presentation?
Charcot’s Triad: RUQ pain, Jaundice, Fever
Reynold’s Pentad: Charcot’s Triad + Septic shock & AMS (can be rapidly fatal)
What does RUQ U/S detect well?
Gallstones, biliary tract dilatation, or CBD stones
Gallstones & biliary tract dilatation
NOT CBD stones
Most serious & dreaded complication of acute cholangitis?
Hepatic abscess
Cholangitis – Tx?
IV ABX & Fluids
2. Decompress CBD via PTC (catheter drainage). Then ERCP (sphincterotomy) or laparotomy (T-tube insertion) once the patient is stabilized (or emergently if pt doesn’t respond to ABX)
What is “Porcelain Gallbladder”?
Intramural calcification of the gallbladder wall
- prophylactic cholecystectomy is rec’d b/c 50% of these progress to cancer
Primary Sclerosing Cholangitis – pot’l complications?
Cirrhosis, Portal HTN, Liver failure
Primary Sclerosing Cholangitis – ass’d more w/ UC or CD?
Moreso w/ UC (in 50-70% of cases, the pt has UC)
Primary Sclerosing Cholangitis – presentation?
Jaundice (chronic obstructive) & pruritis
- Fatigue, malaise, weight loss
