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Gastroenterology > Gallbladder/Biliary Tract Disorders > Flashcards

Gallbladder/Biliary Tract Disorders Flashcards

1
Q

Hormone responsible for release of bile into duodenum

A

CCK

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2
Q

Which duct temporarily stores bile in the gallbladder?

A

cystic duct

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3
Q

formation of gallstones (choleliths) which are solid concretions of varying quantities of cholesterol, ca+, and bilirubin which usually form in the GB

A

cholelithiasis

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4
Q

What leads to the formation of cholesterol stones?

A

Supersaturation of bile with cholesterol and GB hypomotility

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5
Q

How do you differentiate between polyp and gallstone on ultrasound?

A

stone will cast a shadow whereas a polyp will not

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6
Q

Treatment for symptomatic cholelithiasis

A

cholecystectomy

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7
Q

stone erodes through GB wall and develops a cholecystoenteric fistula leading to obstruction of narrowest segment of bowel

A

gallstone ileus

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8
Q

Known protective factor for gallstones

A

statins

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9
Q

The presence of gallstones within the CBD. LFT’s (ALT, AST) are elevated, bilirubin and alk phos may be elevated

A

choledocholithiasis

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10
Q

Treatment recommendation of choledolithiasis to prevent acute cholangitis, acute pancreatitis, and hepatic abscesses

A

removal of all bile duct stones

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11
Q

Gold standard for diagnosis of CBD stones, and sphincter of Oddi dysfunction

A

Endoscopic Retrograde Cholangiopancreatography (ERCP)

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12
Q

Detects choledocholithiasis, neoplasms, strictures, biliary dilations. Minimally invansive, but cannot sample bile, test cytology, remove stone

A

Magnetic resonance cholangiopancreatography (MRCP)

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13
Q

A syndrome of RUQ pain that may radiate to right shoulder, fever, and leukocytosis associated with gallbladder inflammation usually caused by cystic duct obstruction. often occurs after fatty meal

A

acute cholecystitis

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14
Q

main cause of acute cholecystitis

A

impacted gallstone

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15
Q

Physical exam manuever that is useful for differentiating pain in the right upper quadrant. positive in cholecystitis, but negative in choledocholithiasis

A

Murphy’s sign

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16
Q

The imaging modality of choice for the gallbladder. fast, real-time, non-invasive, and does not utilize ionizing radiation

A

abdominal ultrasound

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17
Q

What does slow uptake of HIDA indicate?

A

hepatic parenchymal disease

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18
Q

What does filling of GB/CBD w/delayed or absent filling of intestine with HIDA indicate?

A

obstruction of ampulla

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19
Q

What does non-visualization of GB w/ filling of the CBD and duodenum with HIDA indicate?

A

cystic duct obstruction and acute cholecystitis

20
Q

Describe a normal HIDA scan

A

Early filling of the GB at 15 minutes and complete filling by 25 minutes

21
Q

Preferred treatment for acute cholecystitis

A

laproscopic cholecystectomy

22
Q

A rare form of acute cholecystitis, which occurs when air appears in the GB wall 2ndry to infection w/ gas forming anerobes. Associated with DM

A

emphysematous cholecystitis

23
Q

Gender differences between emphysematous cholecystitis and acute cholecystitis

A

Men are affected twice as commonly as women in emphysematous cholecystitis, where as the reverse is true in most cases of acute cholecystitis

24
Q

RUQ pain that comes and goes, may be referred to right shoulder or right scapula, subsides in 30 minutes. Usually precipitated by a fatty meal. N/V but no fever and WBC normal

A

chronic cholecystitis

25
Q

Extensive calcium encrustation of the gallbladder wall and blue appearance of gallbladder. common manifestation of chronic cholecystitis

A

porcelain gallbladder

26
Q

Cancer associated with porcelain gallbladder

A

adenocarcinoma

27
Q

Primarily cause of acute cholangitis

A

bacterial infection

28
Q

Most important presdisposing factor for acute cholangitis

A

biliary obstruction and stasis secondary to biliary calculi (CBD stone) or benign stricture

29
Q

What are the components of Charcot’s triad?

A

RUQ pain, jaundice, and fever/chills

30
Q

life threatening sepsis this is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture

A

septic cholangitis

31
Q

A chronic inflammatory cholestatic disease. Progressive destruction of bile ducts may progress to cirrhosis, end-stage liver disease. Closely associated with ulcerative colitis. Increased risk of cholangiocarcinoma, gallbladder CA, colon CA and hepatocellular carcinoma

A

sclerosing cholangtitis

32
Q

How is diagnosis of sclerosing cholangitis made in addition to ANCA?

A

characteristic multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts on ERCP

33
Q

Treatment for sclerosing cholangitis

A

Balloon dilation or stenting. Only liver transplant has shown improved survival

34
Q

Slowly progressive autoimmune liver disease. 90% females. Portal inflammation and autoimmune destruction of intrahepatic bile ducts. Leads to cirrhosis and liver failure

A

primary biliary cirrhosis (PBC)

35
Q

Antibody test that is positive in 90-95% of primary biliary cirrhosis (PBC)

A

antimitochondrial antibody (AMA)

36
Q

Treatment for primary biliary cirrhosis (PBC) that reduces risk of liver transplantation and death over 4 years, reduces bilirubin, LFT’s, cholesterol and IgM. Delays fibrosis and varices

A

UDCA (ursodiol)

37
Q

Usually first sign of carcinoma of the biliary tract (Cholangiocarcinoma)

A

progressive jaundice

38
Q

Prognosis for cholangiocarcinoma

A

For non-resectable cases, the 5-year survival rate is 0%. Overall median duration of survival is less than 6 months

39
Q

Cancer with High incidence in S America (Chile) maybe due to high prevalence of gallstones and/or salmonella infection

A

gallbladder cancer

40
Q

Most common histology of gallbladder cancer

A

adenocarcinoma

41
Q

formed by the union of the pancreatic duct and the common bile duct. specifically located at the major duodenal papilla

A

ampulla of Vater

42
Q

Where does cancer of the intestinal mucosa most commonly occur (when it does occur)?

A

ampulla of Vater

43
Q

considered the standard approach for ampullary cancer

A

Whipple operations

44
Q

Bound to albumin because insoluble in water. Transported into hepatocyte & conjugated

A

unconjugated bilirubin

45
Q

The most common hereditary cause of increased bilirubin. Produces an elevated level of unconjugated bilirubin in the bloodstream. Caused by a 70-80% reduction in the glucuronidation activity of the UGT1A1 enzyme

A

Gilbert’s syndrome

46
Q

Bilirubin lab results for Gilbert’s syndrome

A

elevated unconjugated bilirubin (indirect) bilirubin, while conjugated (direct) bilirubin is usually WNL

Gastroenterology (19 decks)

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