Gallbladder disorders Flashcards
Cholelithiasis
Formation of gallstones generally in the gallbladder.
Gallstones are made of?
Cholesterol
Ca+
Bilirubin
Most common type of gallstone?
Cholesterol stone
Gallstone S/S
Generally asymptomatic
Biliary colic
RUQ pain to R shoulder
May occur after ingestion of fatty foods.
5 F’s of gallstones
Female Forty Fat Fertile Flatulence
Gallstone tx
Observation
Cholecystectomy
Gallstone protective factors
Statins Ascorbic acid Coffee Vegetable protein Unsaturated fats
Choledocholithiasis
Presence of gallstones in the cystic bile duct.
Choledocholithiasis S/S
RUQ pain
Epigastric pain
N/V
ALT, AST elevated
ERCP
Endoscopic Retrograde Cholangiopancreatography.
Gold standard for dx and tx of Choledocholithiasis.
Acute cholecystitis
Gall bladder inflammation
90% caused by impacted gallstone.
10% by bile stasis.
Acute cholecystitis S/S
Murphys sign
RUQ pain
Fever
Leukocytosis
Cholescintigraphy
HIDA scan
FUnctional assesment of the hepatobiliary tree
Slow uptake in HIDA scan
Hepatic parenchymal dz
Non-visualization of GB w/ filling of CBD and duodenum =
Cystic duct obstruction and acute cystitis.
Acute cholecystitis tx
Admit, NPP, IV fluids and analgesia,.
Abx (cipro, flagyl)
Surgery
Emphysematous Cholecystitis
Rare form of cholecystitis
Air in GB wall from anaerobes
Men > women
50 - 70 yrs
Chronic cholecystitis
Occurs after repeated mild attacks.
Usually due to stones
Shrinking, scarring, thickening, fibrosis
Chronic cholecystitis S/S
intermittent RUQ pain that subsides in 30 mins.
Variable intervals, days to years
Chronic cholecystitis tx
Surgical removal
Porcelain Gallbladder
Extensive calcification of GB
Blue discoloration of GB wall at surgery.
Usually found incidentally
Porcelain gallbladder is associated with?
GB adenocarcinoma
Should be removed.
Cholangitis
Inflammation of bile duct system.
Usually bacterial, bugs ascend from duedenum.
Usually secondary to biliary obstruction
Charcot’s Triad
For Cholangitis
RUQ Pain
Jaundice
Fever and chills
Septic Cholangitis
Severe complication.
50% mortality
Cholangitis Tx
Admit
IV Abx
ERCP
Blood cultures
Primary Sclerosing Cholangitis
Diffuse biliary tract inflamation
Fibrosis, strictures develop
Can lead to cirrhosis
Men 20-40
Primary sclerosing Cholangitis is associated with?
Ulcerative colitis
Primary Sclerosing Cholangitis Presentation
Progressive jaundice Malaise, fatigue, anorexia Cirrhosis, portal htn ELevated alk phos, ALT, AST ANCA
Primary Sclerosing Cholangitis Tx
Stenting may help
Liver transplant
Primary Biliary Cirrhosis (PBC)
Slowly progressive autoimmune liver dz
Destruction of intrahepatic bile ducts
Leads to cirrhosis and failure
PBC is mostly males or females?
Females (90%) in their 40’s
Which antibody do PBC patients have?
AMA (antimitochondrial antibody)
PBC S/S
50% asymptomatic *Fatigue and pruritis* Hyperpigmentation Portal htn Hepatomegaly
PBC dx
Need 2-3 of:
Positive AMA
Abnormal LFT (esp alk phos, GGTP)
Biopsy shows interlobular destruction
PBC Tx
Ursodeoxycholic acid (UDCA) (Ursodiol) Reduces risk for liver transplant
Cholangiocarcinoma
Rare bile duct cancer
Blockage causes sx
Usually inoperable
Chonalgiocarcinoma S/S
RUQ pain
Progressive jaundice
Anorexia, weight loss, fever
CA 19.9
Cholangiocarcinoma prognosis
Less than 6 months for unrecectable cases.
Gallbladder CA
Rare, highly fatal.
Gallstones are risk factor
Porcelain gallbladder is risk
Ampulla of vater CA
Cancer of older age
Obstructive jaundice
+ FOBT
Whipple to tx
UGT1A1 Gene
Defects in this gene can cause decreased clearance of bilirubin leading to jaundice
Gilberts syndrome
Gilberts syndrome
Most common hereditary cause of increased bilirubin
Generally benign
Mild jaundice may occur
5-10% of pop
Gilberts syndrome labs
Elevated unconjugated (indirect) bilirubin Everything else normal
Which bilirubin is elevated in Gilberts again?
Unconjugated (indirect) bilirubin
ANCA antibody is associated with?
Primary sclerosing cholangitis
