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DEMS 1 > Gall Bladder > Flashcards

Gall Bladder Flashcards

1
Q

Gallbladder (fxn)

A

stores and concentrates bile (fasting)

delivers bile to duodenum (fed state, IN RESPONSE TO DUODENAL RELEASE OF CCK)

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2
Q

Bile (composed of?)

A

bile salts, phospholipids, protein, cholesterol, bilirubin, water+bicarb

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3
Q

Bile ducts

A

conduit for bile

excretion for cholesterol, minerals, certain drugs

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4
Q

Sphincter of Oddi

A

conserves bile acids

prevention of biliary infection (cholangitis)

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5
Q

GALLBLADDER DYSFXN

Cholelithiasis (Risks)

A 
Fat (obesity)
Female
Fertile (pregnancy of estrogen use)
Family Hx
Forty (>30 yrs)
Hispanic or Native Americans, rapid weight loss, biliary stricture
Occur in 10-20% of adults
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6
Q

GALLBLADDER DYSFXN

Cholelithiasis (CHOLESTEROL)

A

50% asymptomatic
CHOLESTROL: white-yellow crystalline, most common
Risks: Cholesterol supersaturation
Phospholipid deficiency

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7
Q

GALLBLADDER DYSFXN

Cholelithiasis (PIGMENT)

A

PIGMENT: black-brown, made of Ca and unconjugated bilirubin, can be from bacterial/parasitic infx/HEMOLYTIC ANEMIA
Risks: biliary obstruction

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8
Q

GALLBLADDER DYSFXN

Cholelithiasis (BROWN)

A

BROWN: develop de novo in bile duct from infx in pts with prostheses (tubes/stents) or downstream obstruction

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9
Q

GALLBLADDER DYSFXN

Cholelithiasis (diagnx/treat)

A 
Abd US (>90% accurate), MRI/CT, MRCP/ERCP
Treat with Cholecystectomy
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10
Q

GALLBLADDER DYSFXN

Cholecystitis (Acute vs Chronic info)

A

Acute: usually with gallstone obstruction of cystic duct, but can be acalulous cholecystits from dehydration, many blood transfusions, vasculitis
Chronic: usually follows repeated episodes of subclinical acute, >90% have gallstones, increased risk of gallbladder cancer

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11
Q

GALLBLADDER DYSFXN

Cholecystitis (Acute pres)

A

Acute: RUQ pain (poss radiation to shoulder or flank), fever, nausea, vomiting
infx/transmural infl leading to inschemia –> can perforate and lead to sepsis

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12
Q

Cholecystitis vs Choledocholithasis

A

Cholecystitis: FEVER
Choledocholithasis: JAUNDICE/DARK URINE

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13
Q

GALLBLADDER DYSFXN

Cholecystitis (Acute diagnx/treat)

A

Elevated Alkaline Phosphatase, acute infl cell infiltrate

Treat: IV fluids, AB, pain meds, NPO, then cholecystectomy when pat is stable in 1-2 weeks

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14
Q

GALLBLADDER DYSFXN

Bacterial (ascending) Cholangitis

A

Bacterial infx above a common bile duct obstruction (ascending)
If sepsis then CHARCOT’S TRIAD: RUQ PAIN + JAUNDICE + FEVER
(with confusion and hypotension then its the Reynold’s Pentad)
Diagnx: urgent ERCP
Treat: IV ABX, ERCP for stone extraction, stent placement

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15
Q

GALLBLADDER DYSFXN

Cholecystitis (Chronic diagnx/treat)

A

fibrosis, chronic infl cells, outpouching of mucosa (Rokitansky-Aschoff sinuses)
TREAT: cholecystectomy

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16
Q

GALLBLADDER DYSFXN

Biliary colic

A

Stone occludes gallbladder intermittently
Pain (intermittent) in epigastrium or RUQ after fatty meals (peaks after 1 hr then gone by 2-6 hrs)
Diagnx with Abd US
No treatment discussed

17
Q

GALLBLADDER DYSFXN

Choledocholithiasis

A

Gallstone obstruction of COMMON BILE DUCT
Epigastic or RUQ WITH jaundice and dark urine
Detect with US/ERCP
Treat: cholecystectomy

18
Q

BILIARY STRICTURE

Benign Biliary Stricture

A

From edema & fibrosis, iatrogenic causes, chronic choledocholithiasis, chronic pancreatitis, primary sclerosing cholangitis
Can lead to CHOLESTASIS (jaundice, dark urine, pruritis, acholic stools)
Diagnx: MRCP/ERCP, CT/US
Treat: surgery

19
Q

Spincter of Oddi dysfxn (SOD)

A

Dysfunctional contraction of SOD, F>M, age 20-50, may lead to epigastric RUQ pain, mimics choledocholithiasis
ELEVATED LFTs during pain, SOD manomerty for definitce diagnx
Treat: spincherotomy

20
Q

BILIARY STRICTURE

Malignant Biliary Stricture

A

Adenocarcinoma of ampulla, pancreatic cancer, other cancers, usually present LATE
Presents as CHOLESTASIS (jaundice, dark urine, pruritis, acholic stools)
Diagnx: MRCP/ERCP, CT/US
Treat: surgery (whipple if early), ERCP with palliative stent placement

21
Q

Gallbladder Carcinoma

A

Elderly with gallstones and/or history of chronic cholecystitis
Asia: link to liver fluke parasite infx
Presents late and invades liver (5 yr survival

DEMS 1 (16 decks)

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