Gallbladder/Biliary Tract Disorders Flashcards
Hormone responsible for release of bile into duodenum
CCK
Which duct temporarily stores bile in the gallbladder?
cystic duct
formation of gallstones (choleliths) which are solid concretions of varying quantities of cholesterol, ca+, and bilirubin which usually form in the GB
cholelithiasis
What leads to the formation of cholesterol stones?
Supersaturation of bile with cholesterol and GB hypomotility
How do you differentiate between polyp and gallstone on ultrasound?
stone will cast a shadow whereas a polyp will not
Treatment for symptomatic cholelithiasis
cholecystectomy
stone erodes through GB wall and develops a cholecystoenteric fistula leading to obstruction of narrowest segment of bowel
gallstone ileus
Known protective factor for gallstones
statins
The presence of gallstones within the CBD. LFT’s (ALT, AST) are elevated, bilirubin and alk phos may be elevated
choledocholithiasis
Treatment recommendation of choledolithiasis to prevent acute cholangitis, acute pancreatitis, and hepatic abscesses
removal of all bile duct stones
Gold standard for diagnosis of CBD stones, and sphincter of Oddi dysfunction
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Detects choledocholithiasis, neoplasms, strictures, biliary dilations. Minimally invansive, but cannot sample bile, test cytology, remove stone
Magnetic resonance cholangiopancreatography (MRCP)
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
acute cholecystitis
main cause of acute cholecystitis
impacted gallstone
Physical exam manuever that is useful for differentiating pain in the right upper quadrant. positive in cholecystitis, but negative in choledocholithiasis
Murphy’s sign
The imaging modality of choice for the gallbladder. fast, real-time, non-invasive, and does not utilize ionizing radiation
abdominal ultrasound
What does slow uptake of HIDA indicate?
hepatic parenchymal disease
What does filling of GB/CBD w/delayed or absent filling of intestine with HIDA indicate?
obstruction of ampulla
What does non-visualization of GB w/ filling of the CBD and duodenum with HIDA indicate?
cystic duct obstruction and acute cholecystitis
Describe a normal HIDA scan
Early filling of the GB at 15 minutes and complete filling by 25 minutes
Preferred treatment for acute cholecystitis
laproscopic cholecystectomy
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
emphysematous cholecystitis
Gender differences between emphysematous cholecystitis and acute cholecystitis
Men are affected twice as commonly as women in emphysematous cholecystitis, where as the reverse is true in most cases of acute cholecystitis
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
chronic cholecystitis
Extensive calcium encrustation of the gallbladder wall and blue appearance of gallbladder. common manifestation of chronic cholecystitis
porcelain gallbladder
Cancer associated with porcelain gallbladder
adenocarcinoma
Primarily cause of acute cholangitis
bacterial infection
Most important presdisposing factor for acute cholangitis
biliary obstruction and stasis secondary to biliary calculi (CBD stone) or benign stricture
What are the components of Charcot’s triad?
RUQ pain, jaundice, and fever/chills
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
septic cholangitis
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
sclerosing cholangtitis
How is diagnosis of sclerosing cholangitis made in addition to ANCA?
characteristic multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts on ERCP
Treatment for sclerosing cholangitis
Balloon dilation or stenting. Only liver transplant has shown improved survival
Slowly progressive autoimmune liver disease. 90% females. Portal inflammation and autoimmune destruction of intrahepatic bile ducts. Leads to cirrhosis and liver failure
primary biliary cirrhosis (PBC)
Antibody test that is positive in 90-95% of primary biliary cirrhosis (PBC)
antimitochondrial antibody (AMA)
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
UDCA (ursodiol)
Usually first sign of carcinoma of the biliary tract (Cholangiocarcinoma)
progressive jaundice
Prognosis for cholangiocarcinoma
For non-resectable cases, the 5-year survival rate is 0%. Overall median duration of survival is less than 6 months
Cancer with High incidence in S America (Chile) maybe due to high prevalence of gallstones and/or salmonella infection
gallbladder cancer
Most common histology of gallbladder cancer
adenocarcinoma
formed by the union of the pancreatic duct and the common bile duct. specifically located at the major duodenal papilla
ampulla of Vater
Where does cancer of the intestinal mucosa most commonly occur (when it does occur)?
ampulla of Vater
considered the standard approach for ampullary cancer
Whipple operations
Bound to albumin because insoluble in water. Transported into hepatocyte & conjugated
unconjugated bilirubin
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
Gilbert’s syndrome
Bilirubin lab results for Gilbert’s syndrome
elevated unconjugated bilirubin (indirect) bilirubin, while conjugated (direct) bilirubin is usually WNL
