Gallstones and Biliary Tract Disease Flashcards
Three common symptoms in choledochal cysts/biliary cysts
Abdominal pain
Palpable mass
Jaundice
Choledochal cysts/biliary cysts are associated with an increased risk of this cancer
Cholangiocarcinoma
Two pathophysiological factors that increase risk of gallstones
High cholesterol in bile
Gallbladder stasis
Murphy’s sign suggests acute cholecystitis. Is it more painful with inspiration or expiration?
Inspiration
Best test and treatment for choledocholithiasis
ERCP
90-95% of acute cholecystitis is caused by …
Gallstones
The common bile and pancreatic duct join and shoot into the intestines here
Sphincter of Oddi
Cholecystitis is more likely when the pain lasts longer than …
Six hours
Treatment for acute cholecystitis
NPO
Prep for surgery, should be done within 96 hours of symptom onset
“Porcelain gallbladder” may be seen in this condition
Chronic cholecystitis
Describe the three components of Charcot’s Triad and in which conditions it might be seen
Fever + Jaundice + RUQ pain
Seen in cholangitis conditions (inflammation of bile ducts)
- choledocholithiasis
- primary sclerosing cholangitis
- pyogenic cholangitis
Most common symptom in cholecystitis and cholecystolithiasis
Biliary colic (functional spasm of cystic duct)
Stones in the gallbladder are called (blank) and stones in the common bile duct are called (blank)
Stones in gallbladder = Cholelithiasis
Stones in common bile duct = Choledocholithiasis
Patients who are most likely to have primary sclerosing cholangitis
Men aged 20-50
This condition is an inflammatory, progressive fibrosis of intra/extrahepatic bile ducts with a median survival of 10-12 years (if no transplant)
Primary sclerosing cholangitis
Which two imaging types to use in acute cholecystitis?
Ultrasound (wall edema, stones, distension, swelling of gallbladder)
Cholescintigraphy aka HIDA scan (IV nuclear test to see if can get something in to gallbladder)
- no visible gallbladder suggests cystic duct obstruction
Describe pyogenic cholangitis
Recurrent cholangitis caused by repeated bacterial infections of the biliary tree
Most gallstones are made of …
Cholesterol
Almost all patients with primary sclerosing cholangitis have this co-occuring GI condition
Ulcerative colitis
Four risk factors for gallstones
Age (start to see after age 40, most after age 60)
Obesity (more cholesterol in body)
Native American
Females
Describe the cause of choledocholithiasis
Stone in common duct, typically comes from gallbladder
Sphincter of Oddi dysfunction can result from these processes
Any process that leads to scarring
(pancreatitis, gallstone passage, infection, cholecystectomy)
Location of pain in cholecystitis and cholecystolithiasis
Pain radiates to back or right shoulder
Diagnostic test of choice for chronic cholecystitis
Ultrasound
Lab tests for acute cholecystitis will show elevated levels of these 3 things
Leukocytosis (12-15,000)
Serum bilirubin
ALP (sign of biliary tree obstruction)
(amylase may be elevated if common duct obstructed)
Two main symptoms in primary sclerosing cholangitis
Pruritus and fatigue
(also pain and weight loss)
Treatment for chronic cholecystitis
Elective cholecystectomy
Ursodiol can break up stones over course of years
Best way to diagnose Sphincter of Oddi dysfunction
ERCP - may reveal dilated common duct
Acute cholecystitis symptoms of nausea, vomiting, and/or RUQ pain are more likely to occur with …
Eating
