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Clin med GI > Gallbladder and biliary disorders > Flashcards

Gallbladder and biliary disorders Flashcards

1
Q

What is cholelithiasis

A

Hardened deposits of digestive fluid that form in the gallbladder

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2
Q

What are the complications with cholelithiasis

A

most disorders of the biliary tract

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3
Q

Who is at increased risk for cholelithiasis

A

those with crohns disease with ileum resection

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4
Q

What are common risk factors for cholelithiasis

A

Female
obesiry
increased age
pregnancy
western diet
American indian ethnicity
+fh

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5
Q

What are the 3 main pathways that gallstones can form

A

cholesterol supersaturation
Excessive bilirubin
impaired contractility

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6
Q

What is cholesterol supersaturation

A

liver produces more cholesterol than bile can dissolve and the excess cholesterol can crystallize

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7
Q

How does excess bilirubin lead to gallstones

A

liver makes too much bilirubin processing breakdown of hemoglobin

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8
Q

Why does gallbladder hypo motility lead to stones

A

gallbladder does not empty effectively causing bile to concentrate

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9
Q

What are the properties of black pigment gallstones

A

small, hard gallstones composed of calcium bilirubinate and inorganic salts

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10
Q

What are the risk factors for black pigmented gallstones

A

ETOH related liver disease, sickle cell, ill disease, chronic hemolysis

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11
Q

What are the properties of brown pigmented gallstones

A

soft and greasy, consisting of bilirubinate and fatty acids

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12
Q

What are the causes of brown pigmented gallstones

A

infection, inflammation, parasitic infection

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13
Q

What is the precursor to cholelithiasis

A

biliary sludge

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14
Q

When does biliary sludge develop

A

during gallbladder stasis (TPN)

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15
Q

What is the most common symptom of cholelithiasis

A

biliary colic

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16
Q

What is biliary colic

A

Temporary obstruction that cause sudden onset of RUQ pain, radiating to scapula (15min-hour) and will gradually resolve in 30-90min.

*generally a nocturnal issue

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17
Q

What is the first line and best imaging modality for cholelithiasis

A

US

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18
Q

If US of gallbladder is equivocal, what is the next line of imaging that can be done

A

nuc med cholescintigraphy scan (HIDA scan)

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19
Q

How do you treat asymptomatic gallstones

A

Diet changes to reduce the chance of recurrent episodes

refer to general surgeon for cholecystectomy

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20
Q

When can stone dissolution be preformed

A

small, radiolucent stones in functioning non-obstructed gallbladder

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21
Q

What can be used for stone dissolution

A

ursodeoxycholic

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22
Q

What is the treatment of choice for cholelithiasis

A

laparoscopic cholecystectomy

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23
Q

If a patient is at risk for cholelithiasis, what else are they at a risk for

A

cholecystitis

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24
Q

How will acute cholecystitis present

A

RUQ pain and tenderness
N/V
Fever / chills

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25
Q

What is the treatment for acute cholecystitis

A

antibiotics and cholecystectomy

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26
Q

What is the most common complication of cholelithiasis

A

acute cholecystitis

27
Q

What is cute emphysematous cholecystitis

A

GB wall infected with gas forming organisms

28
Q

When will Murphys sign be present

A

with acute cholecystitis

29
Q

What is the best test to detect gallstones and evaluate GB disease

A

US

30
Q

Which type of cholecystitis is a HIDA scan more useful to diagnose

A

acute acalculous cholecystitis

31
Q

What is gallstone pancreatitis

A

stones pass into the biliary tract and block pancreatic duct

32
Q

What is a cholecystoenteric fistula

A

large stone erodes GB wall, creating a fistula into the small bowel

may pass freely but could cause ileus

33
Q

What is the classic mantra for cholecystitis

A

fat, forty, fertile, female, flatulent

34
Q

What is a porcelain gallbladder

A

Extensive calcification due to fibrosis

35
Q

What is the classic PE findings with chronic cholecystitis

A

+murphys sign
uncomfortable but not acutely ill
vitals WNL

36
Q

What is the test of choice for chronic cholecystitis

A

US unless aclculous

37
Q

What is the preferred treatment for chronic cholecystitis

A

laparoscopic cholecystectomy

38
Q

What is choledocholithiasis

A

Stone in the CBD

39
Q

What is the treatment for choledocholithiasis

A

ERCP

*possible cholecystectomy

40
Q

What is the clinical presentation of choledocholithiasis

A

Colicky, RUQ pain, clay colored stools, episodic icterus (jaundice)

41
Q

What is courvoisers sign

A

presence of palpable GB

42
Q

What T.bili level is strongly associated with choledocholithiasis

A

> 3-4 mg/dL

43
Q

What bloodwork should be drawn when working up choledocholithiasis

A

WBC, Hb/Hct, platelets, T. bili, D. bili, Alk phos, ALT, AST

44
Q

What is the first test to be done if there is any suspicion of biliary disease

A

abdominal ultrasound

45
Q

What is an ERCP

A

Endoscopic stone fragmentation may be considered for stones not easily removed

46
Q

What is charcots triad

A

abd pain
jaundice
fever / chills

47
Q

What is Reynolds pentad

A

confusion, hypotension, abdpain, jaundice, fever/chills

48
Q

What is acute cholangitis

A

CBD obstruction allows bacteria to ascend from the duodenum

49
Q

What are common organisms that cause cholangitis

A

E.coli
Enterobacter
Klebseilla

50
Q

What is recurrent pyogenic cholangitis

A

oriental cholangiohepatitis

*intrahepatic brown stone formation that occurs in Southeast Asia

51
Q

How do you treat acute cholangitis

A

agressive supportive care w/ urgent stone removal endoscopically or surgically

52
Q

What is primary sclerosis cholangitis

A

chronic and progressive patchy inflammation, fibrosis, and strictures of bile ducts w/ no known cause

53
Q

What do most people with primary sclerosing cholangitis already have

A

inflammatory bowel disease
*ulcerative colitis

54
Q

How do you diagnose primary sclerosing cholangitis

A

ERCP

55
Q

How do you treat advanced primary sclerosing cholangitis

A

liver transplant

56
Q

What gender is at highest risk for primary sclerosing cholangitis

A

men

57
Q

What are the different types of primary sclerosing cholangitis

A

classic
small-duct
association with autoimmune hepatitis

58
Q

What is primary sclerosing cholangitis

A

progressive fibrosis around intrahepatic bile ducts that lead to concentric and circumferential lamination
*onion skin fibrosis

59
Q

What will be seen on physical exam with primary sclerosing cholangitis

A

hepatomegaly
splenomegaly
jaundice
excoriations from pruritis

60
Q

What is indicative of the terminal phase of primary sclerosing cholangitis

A

decompensated cirrhosis
portal HTN
ascites
liver failure

61
Q

How do you diagnose primary sclerosing cholangitis

A

cholangiography showing multiple strictures and dilations in intrahepatic and extra hepatic bile ducts

62
Q

What is the only treatment that improves life expectancy with primary sclerosing cholangitis

A

liver transplant

63
Q

If a patient has +PSC and IBD, what are they at an increased risk for

A

colorectal cancer

64
Q

What is a TIPS procedure

A

Transjugular Intrahepatic portosystemic shunt

Clin med GI (9 decks)

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