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STEP 2 GI > Gallbladder 10-27 (1) > Flashcards

Gallbladder 10-27 (1) Flashcards

1
Q

CHOLELITHIASIS definition.

A

stones in gallbladder.

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2
Q

CHOLELITHIASIS 3 symptoms?

A

Colicky RUQ pain. Radiates to the shoulder. Worse with fatty foods.

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3
Q

CHOLELITHIASIS diagnosis?

A

RUQ Ultrasound

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4
Q

CHOLELITHIASIS 2 treatment?

A

Cholecystectomy elective.

Ursodeoxycholic acid for nonsurgical patients.

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5
Q

Cholecystitis. definition?

A

stones in cystic duct, causing inflammation of gallbladder.

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6
Q

Cholecystitis. CP? what sign?

A

Constant RUQ pain, positive Murphy’s sign, fever, leukocytosis.

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7
Q

Cholecystitis. what is murphy sign? (also known as Sweeney’s sign.

A

stops breathing when palpated

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8
Q

Cholecystitis. diagnosis? first method?

A

US: pericholecystic fluid, thickened gallbladder wall, and gall stones.

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9
Q

Cholecystitis. diagnosis. if US negative?

A

HIDA scan: failure of filling of gallbladder.

hepatobiliary iminodiacetic acid (HIDA) scan

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10
Q

Cholecystitis. treatment?

A

NPO, IVF
IV Abx; if complicated; signs of sepsis.
Urgent cholecystectomy.

Nonsurgical patient: cholecystostomy & bile acid dissolution therapy (ursodeoxycholic acid) for 6 to 24 months.

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11
Q

Cholecystitis. treatment if nonsurgical patients?

A

Nonsurgical patient: cholecystostomy & bile acid dissolution therapy (ursodeoxycholic acid) for 6 to 24 months.

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12
Q

2 cholecystitis complications?

A

Bile acid diarrhea due to fistulas with the large bowel.

Gallstone ileus: biliary-enteric fistula with small bowel.

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13
Q

cholecystitis. gallstone ileus. CP?

A

CP: Nausea and vomiting; Abdominal distention; Hyperactive bowel sounds; Inability to pass stool and flatus; Intermittent tumbling obstruction with diffuse abdominal pain and vomiting until finally lodging in the ileum.

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14
Q

cholecystitis. gallstone ileus. diagnosis? 2

A

X-ray
CT

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15
Q

cholecystitis. gallstone ileus. what shows xray?

A

Dilated bowel loops, multiple air-fluid levels, and pneumobilia (air in biliary tree).

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16
Q

cholecystitis. gallstone ileus. CT scan is confirmative. what seen?

A

Pneumobilia. Gallbladder wall thickening. Obstructing stone.

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17
Q

cholecystitis. gallstone ileus. management?

A

Surgical removal of stone (enterolithotomy) and cholecystectomy.

Possible bowel resection.

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18
Q

EMPHYSEMATOUS CHOLECYSTITIS, definition?

A

gallbladder infection due to gas-producing mo/s

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19
Q

Emphysematous cholecystitis. CP?

A

Fever, RUQ pain, nausea/vomiting
Crepitus in abdominal wall adjacent to gallbladder, Ileus (decr. Or absent bowel sounds)

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20
Q

Emphysematous cholecystitis. diagnosis. what method preffered

A

CT is preferred over US

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21
Q

Emphysematous cholecystitis. 2 complications?

A

gangrene and perforation

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22
Q

Emphysematous cholecystitis. risk factors?

A

DM
vascular compromise
immunosupression

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23
Q

Emphysematous cholecystitis. what is seen on imaging? CT

A

air-fluid levels in gallbladder, gas in its wall

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24
Q

Emphysematous cholecystitis. labs?

A

unjonjugated hyperbilirubinemia, mildly elevated aminotransferases

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25
Q

Emphysematous cholecystitis. what cultures?

A

cultures with gas forming Ecoli, clostridia

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26
Q

Emphysematous cholecystitis. treatment?

A

Emergent cholecystectomy

broad abs with clostridium coverage (eg ampicillin-sulbactam).

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27
Q

Acalculous cholecystitis.

Never had a gallbladder disease before.

Diagnosis by a high degree of suspicion and imaging studies.

A

.

28
Q

Acalculous cholecystitis.
risk factors?

A

Severe trauma or recent surgery

Prolonged fasting or TPN

Critical illness (sepsis, ICU)

29
Q

Acalculous cholecystitis. clinical?

A

Fever, leukocytosis, incf. LFTs, RUQ pain

Jaundince and RUQ mass is less common

30
Q

Acalculous cholecystitis. diagnosis?

A

US preffered
HIDA or CT if needed

31
Q

Acalculous cholecystitis. treatment?

A

Enteric abs coverage

Cholecystostomy for initial drainage

Cholecystectomy one clinically stable

32
Q

Management of gallstones.

stones without symptoms?

A

No treatment required in most patients

33
Q

Management of gallstones.

stones with typical biliary colic symptoms? 2

A

elective laparoscopic cholecystectomy

possible ursodeoxycholic acid in poor surgical candidates

34
Q

Management of gallstones.

complicated gallstone disease *

*acute cholecystitits, choledocholithiasis, gallstone pancreatitis.

A

cholecystectomy within 72 h

35
Q

what in included in complicated gallstone disease?

A

*acute cholecystitits, choledocholithiasis, gallstone pancreatitis.

36
Q

Postcholecystectomy syndrome. when manifests?

A

Postoperative (early) or months to years (late) after cholecystectomy.

37
Q

Postcholecystectomy syndrome. due to 2 groups of reasons?

A

Can be due to biliary (retained CBD or cystic duct stone, biliary dyskinesia)
OR
extra-biliary (pancreatitis, PUD, CAD).

Sphincter of Oddi dysfunction; either stenosis or dyskinesia (SOD). Can be triggered by opioid medication (morphine).

38
Q

Postcholecystectomy syndrome. CP?

A

Persistent abdominal pain. Dyspepsia.

39
Q

Postcholecystectomy syndrome. labs? transferazes visokios

A

Elevated ALP.
Abnormal aminotransferases.
Dilated CBD on abdominal US. SOD –> SOD manometry.

SOD = stenosis or dyskinesia

40
Q

Postcholecystectomy syndrome. management?

A

Endoscopic US, ERCP, or MRCP.

Directed at causative agent.

SOD –> sphincterotomy.

41
Q

Choledolithiasis. definition?

A

stone in common bile duct

42
Q

Choledolithiasis. CP?

A

C/P: Gallstone pancreatitis. Hepatitis. Obstructive jaundice. Painful. Positive Murphy’s sign. Fever. Leukocytosis.

43
Q

Choledolithiasis. diagnosis?

A

RUQ US: obstruction.
If negative –> MRCP.

44
Q

Choledolithiasis. treatment?

A

Treatment: NPO. IVF fluids. IV Abx if complicated; sepsis.

Urgent ERCP: sphincterotomy & elective cholecystectomy.

Or urgent cholecystectomy.

45
Q

Choledolithiasis. followup?

A

Follow up: ball-valve effect: stone goes up and down the duct; might show improvement but stone is still there so ERCP is required.

46
Q

Acute cholangitis. etiology?

A

Ascending infection due to billiary obstruction

47
Q

Acute cholangitis. CP?

A

fever, jaundice, RUQ pain (Charcot triad)

+/- hypotension, AMS (Reynolds pentad)

48
Q

Acute cholangitis. labs?

A

Leukocytosis with a left shift.

Direct hyperbilirubinemia.

Elevated ALP.

Anion gap metabolic acidosis from lactic acidosis.

49
Q

Acute cholangitis. what is Charcot triad?

A

fever, jaundice, RUQ pain (Charcot triad)

50
Q

Acute cholangitis. what is Reynolds pentad?

A

fever, jaundice, RUQ pain (Charcot triad)

+/- hypotension, AMS (Reynolds pentad)

51
Q

Acute cholangitis. diganosis? labs

A

Cholestatic liver function abnormalities:
–> incr. direct bilirubin, alkaline phosphatase
–> mildly incr. aminotransferases

52
Q

Acute cholangitis. US/CT findings?

A

biliary dilation on US or CT

53
Q

Acute cholangitis. treatment?

A

abs coverage of enteric bacteria
biliary drainage by ERCP within 24-48h

buvo abs pamineti:
Ciprofloxacin plus metronidazole.
Ampicillin/gentamicin plus metronidazole.

dar buvo papildomai prierasas:
Therapeutic and diagnostic: emergent ERCP. Other options: percutaneous transhepatic cholangiography and open surgical decompression.

Urgent cholecystectomy.

54
Q

porcelain. definition?

A

Calcium-laden gallbladder wall with bluish color and brittle consistency.

Associated with chronic cholecystitis.

55
Q

porcelain. CP?

A

Asymptomatic. RUQ pain. Firm and nontender RUQ mass in PE.

56
Q

porcelain. diagnosis? xray and CT

A

X-ray shows a rim like calcification in the area of the gallbladder.

CT scan reveals a calcified rim in the gallbladder wall with central bile-filled dark area.

57
Q

porcelain. treatment?

A

cholecystectomy

58
Q

porcelain. Increased risk for gallbladder adenocarcinoma.

A
59
Q

Cholangiocarcinoma. definition?

A

Malignancy of the bile duct epithelium.

60
Q

Cholangiocarcinoma. risk factors?

A

Fibropolycystic liver disease. PSC.

61
Q

Cholangiocarcinoma. CP?

A

Abdominal pain.
Weight loss. Hyperbilirubinemia.
Cholestatic liver enzyme pattern.
Hepatomegaly and palpable RUQ mass.

62
Q

Cholangiocarcinoma. diagnosis? labs

A

Elevated CEA.
Elevated Ca19-9.
Normal AFP.

63
Q

Cholangiocarcinoma. diagnosis instrumental?

A

Abdominal imaging: intrahepatic or CBD dilation and biliary mass.

EUS or ERCP required for diagnosis.

64
Q

bile acid diarrhea. pathophysiology?

A

Unresorbed bile acids spill into the colon, resulting in mucosal irritation

-> bile acid enters terminal ileum too rapidly and overwhelms resorptive capacity (eg post cholecystectomy)

-> ileal disease impairs bile absorption (eg Crohn disease, abdominal radiation damage)

65
Q

bile acid diarrhea. clinical? 3

A

Secretory diarrhea (eg fasting diarrhea, nocturnal episodes)

Bloating, abdominal cramps

Unremarkable serum and stool studies

66
Q

bile acid diarrhea. treatment?

A

bile acid-binding resins (eg cholestyramine, colestipol)

STEP 2 GI (16 decks)

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