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Gastroenterology > Gallbladder and Biliary Disorders > Flashcards

Gallbladder and Biliary Disorders Flashcards

1
Q

What is cholelithiasis (gallstones)?

A

Hardened deposits of digestive fluid that form in gallbladder

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2
Q

Are cholelithiasis typically symptomatic?

A

No, most commonly asymptomatic and do not require treatment

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3
Q

What are the risk factors associated with gallstones?

A
  • Female sex
  • Obesity
  • Increased age
  • Pregnancy/OCPs
  • American Indian ethnicity
  • Western diet, TPN
  • Rapid weight loss
  • Family history
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4
Q

What disease process is at high risk for gallstones and should be monitored closely?

A

Chrohn’s disease, they can’t breakdown bile

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5
Q

What are the three main pathways in which gallstones are formed?

A
  • Cholesterol supersaturation
  • Excess bilirubin
  • Gallbladder hypo-motility or impaired contractility
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6
Q

What is the most common presenting symptom with gallstones?

A

Biliary colic (RUQ pain radiating to scapula; most commonly at night. Pain comes and goes)

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7
Q

What are the essentials in diagnosing gallstones?

A
  • Often asymptomatic.
  • Classic biliary pain (“episodic gallbladder pain”) characterized by infrequent episodes of steady severe pain in epigastrium or right upper quadrant with radiation to right scapula.
  • Gallstones detected on ultrasonography.
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8
Q

What is the treatment of gallstones?

A

No treatment required for asymptomatic gallstones - diet changes and can refer to general surgeon

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9
Q

What medication can be used for stone dissolution?

A

Actigall/Ursodiol (not as effective, can be used in small stones)

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10
Q

What is the treatment of choice for symptomatic gallstones?

A

Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallbladder disease

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11
Q

What are the essentials of diagnosis for acute cholecystitis?

A
  • Steady, severe pain and tenderness in the right hypochondrium or epigastrium.
  • Nausea and vomiting.
  • Fever and leukocytosis.
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12
Q

Where is the gallstone typically obstructing in acute cholecystitis?

A

Cystic duct

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13
Q

What are the 4 F’s of acute cholecystitis?

A

Female, Fat, Forty, and Fertile

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14
Q

How is acute cholecystitis diagnosed?

A

Transabdominal gallbladder US

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15
Q

What sign will be positive on physical exam in acute cholecystitis?

A

Murphy’s sign

*RUQ pain/tenderness with deep palpation during inspiration (halts inspiration)

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16
Q

Although not diagnostic, what labs should be run when working up acute cholecystitis and what are some possible findings?

A

CBC, CMP
Amylase, lipase to r/o pancreatitis

WBC- possible leukocytosis with left shift
LFT’s- normal to slightly elevated
Bilirubin maybe slightly elevated

17
Q

Although US is the best imaging modality for diagnosing acute cholecystitis what imaging modality is used typically as first line in the ED?

A

CT

*if CT and US are equivalent should then get HIDA scan

18
Q

What is acute acalculous cholecystitis?

A

Cholecystitis without stones (can’t be ignored and typically why HIDA scans are routinely done when suspected)

19
Q

What complication will result in untreated acute acalculous cholecystitis?

A

GB gangrene

20
Q

What are the essentials of diagnosis for choledocholithiasis?

A
  • Often a history of biliary pain, which may be accompanied by jaundice.
  • Occasional patients present with painless jaundice.
  • Nausea and vomiting.
  • Cholangitis should be suspected with fever followed by hypothermia and gram-negative shock, jaundice, and leukocytosis.
  • Stones in bile duct most reliably detected by ERCP or EUS.
21
Q

Where is the stone located in choledocholithiasis?

A

Common bile duct

22
Q

What is the presentation of choledocholithiasis?

A

Pain (colicky, RUQ)
Episodic hx epigastric, RUQ pain
Episodic icterus/jaundice
Clay colored stools, tea colored urine

23
Q

What will be the color of stool in choledocholithiasis?

A

Clay colored stools

24
Q

In choledocolithiasis, increased levels of bilirubin will lead to what color urine?

A

Tea colored urine

25
Q

What is Courvoisier’s sign?

A

Presence of palpable GB (GB dilation due to obstruction of bile duct)

*Seen in choledocholithiasis

26
Q

Will T. bili be increased in choledocholithiasis?

A

Increased, > 4 mg/dL

27
Q

What is the first line imaging in working-up choledocholithiasis?

A

ABD Ultrasound

28
Q

What is the treatment for choledocholithiasis?

A

ERCP (with sphincterotomy to remove stones)

29
Q

What is the etiology of cholangitis?

A

Stone in CBD which causes obstruction allowing for bacteria to ascend from duodenum

30
Q

What is Charcot triad?

A

Abdominal pain
Jaundice
Fever and chills

*seen in cholangitis

31
Q

What is Reynolds’ pentad?

A

Confusion
Hypotension
Abdominal pain
Jaundice
Fever or chills

32
Q

What is the treatment for cholangitis?

A

Emergency removal of stones (surgically or endoscopically)

Antibiotics - meropenem, cipro, plus metronidazole

33
Q

How do you diagnose primary sclerosing cholangitis?

A

ERCP

34
Q

What is the treatment for primary sclerosing cholangitis?

A

Liver transplant

35
Q

What are the three subtypes of sclerosing cholangitis?

A
  1. Classic: affects small and large bile ducts
  2. Small-duct: affects only small duct
  3. Autoimmune hepatitis
36
Q

Ulcerative colitis (IBD) and autoantibodies increase the risk of what disorder?

A

Primary sclerosing cholangitis (PSC)

*80% of patients have IBD or autoantibodies

37
Q

PSC is typically asymptomatic, how is PSC typically discovered?

A

Elevated LFT’s

Gastroenterology (12 decks)

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