Gastrointestinal Flashcards
1
Q
Relative to pairing and branching, arteries supplying GI structures vs non-GI structures are:
A
Arteries supplying GI structure:
- single and branch anteriorly
Arteries supplying non-GI structure:
- paired and branch laterally and posteriorly
2
Q
The 2 areas of the colon have dual blood supply from distal arterial branches (ie, called ———, that are susceptible in ———) are ——— and ———
A
- “watershed areas”
- colonic ischemia
- Splenic flexure — SMA and IMA
- Rectosigmoid junction — IMA branches (last sigmoid arterial branch and superior rectal artery) and hypogastric (internal iliac) artery
3
Q
Nutcracker syndrome results from compression of ——— between ——— and ———
A
- left renal vein
- superior mesenteric artery
- aorta
4
Q
Nutcracker syndrome may cause what syptoms (list 3):
A
- abdominal (flank) pain
- gross hematuria (from rupture of thin-walled renal varicosities)
- left-sided varicocele
5
Q
Superior mesenteric artery syndrome is characterized by ——— symptoms (primarily ———) when ——— and ——— compress ———
A
- intermittent intestinal obstruction
- postprandial pain
- SMA
- aorta
- transverse (third) portion of duodenum
6
Q
Superior mesenteric artery syndrome
typically occurs in conditions associated with ——— (eg, ———)
A
- diminished mesenteric fat
- rapid weight loss, low body weight, malnutrition, gastric bypass surgeries
7
Q
The functional unit of the liver is made up of ——— arranged lobules surrounding the ——— with ——— on the edges (consisting of ———)
A
- hexagonally
- central vein
- portal triads
- a portal vein, hepatic artery, bile ducts, as well as lymphatics
8
Q
Apical surface of hepatocytes face ———, and basolateral surface face ———
A
- bile canaliculi
- sinusoids
9
Q
Kupffer cells (specialized ———) located in ———, function to ———
A
- macrophages
- sinusoids
- clear bacteria and damaged or senescent RBCs
10
Q
Hepatic stellate (Ito) cells in ——— function to ——— (when quiescent) and ——— (when activated); Responsible for hepatic ———
A
- space of Disse
- store vitamin A
- produce extracellular matrix
- fibrosis
11
Q
Dual blood supply to liver composed of:
A
portal vein (~80%) and hepatic artery (~20%)
12
Q
Zone I of the liver is called the ——— zone; Affected 1st by ——— and ———; Best ———, and thus most ———
A
- periportal
- viral hepatitis
- ingested toxins (eg, cocaine)
- oxygenated
- resistant to circulatory compromise
13
Q
Zone II of the liver is the ——— zone; Affected in ———
A
- intermediate
- yellow fever
(Zone II = yeLLow fever)
14
Q
Zone III of the liver is the ——— zone; Affected 1st by ——— (because least ———); High concentration of ———; Most sensitive to ———; Site of ———
A
- pericentral (centrilobular)
- ischemia
- oxygenated
- cytochrome P-450
- metabolic toxins (eg, ethanol, CCl4, rifampin, acetaminophen)
- alcoholic hepatitis
15
Q
List the 6 components of bile:
A
- bile salts (bile acids conjugated to glycine or taurine, making them water soluble)
- phospholipids
- cholesterol
- bilirubin
- water
- ions
16
Q
Enzyme that catalyzes rate-limiting step of bile acid synthesis?
A
Cholesterol 7α-hydroxylase
17
Q
List 3 functions of bile:
A
- Digestion and absorption of lipids and fat-soluble vitamins
- Bilirubin and cholesterol excretion (body’s 1° means of elimination)
- Antimicrobial activity (via membrane disruption)
18
Q
Decreased absorption of enteric bile salts at ——— (as in ———) prevents normal ——— and may cause ———
A
- distal ileum
- short bowel syndrome, Crohn disease
- fat absorption
- bile acid diarrhea
19
Q
When decreased absorption of enteric bile: calcium, which normally binds ———, binds ——— instead, free ——— is absorbed by gut, increasing frequency of ———
A
- oxalate
- fat
- oxalate
- calcium oxalate kidney stones
20
Q
In terms of synthesis of bilirubin: ——— from old RBCs is taken up by ———
A
- hemoglobin
- macrophages
21
Q
In terms of synthesis of bilirubin: Heme is metabolized by ——— to ——— (color: ———), which is subsequently reduced to ——— (color: ———)
A
- heme oxygenase
- biliverdin
- green
- bilirubin
- yellow-brown
22
Q
In terms of synthesis of bilirubin:
Unconjugated (———) bilirubin is released from macrophages into the plasma where it combines with ———
A
- indirect
- albumin
23
Q
In terms of synthesis of bilirubin:
Unconjugated bilirubin is removed from blood by ———, conjugated with ——— by ———, and excreted in ———
A
- liver
- glucuronate
- UDP glucuronosyl transferase
- bile
24
Q
Contrast the conjugation and water solubility of direct vs indirect bilirubin:
A
Direct bilirubin: conjugated with glucuronic acid; water soluble (dissolves in water)
Indirect bilirubin: unconjugated; water insoluble
25
In intestines, some conjugated bilirubin converted by bacteria to ——— (soluble)
- urobilinogen
26
Some urobilinogen excreted in feces as ——— (color: ———); and some reabsorbed through intestinal mucosa back into blood, where it can be excreted by ——— into ———, or excreted by ——— into ——— as ——— (color: ———)
- stercobilin
- brown color of stool
- liver
- gut
- kidney
- urine
- urobilin
- yellow color of urine
27
Jaundice refers to ——— due to ———
- an abnormal yellowing of the skin and/or sclera
- bilirubin deposition (Hyperbilirubinemia 2° to increased production or decreased clearance (impaired hepatic uptake, conjugation, excretion))
28
List 4 common causes of elevated bilirubin level:
HOT Liver:
Hemolysis
Obstruction
Tumor
Liver disease
29
The ——— is a muscular valve responsible for controlling the flow of bile and pancreatic secretions through the ——— into the second part of the duodenum
- sphincter of Oddi
- ampulla of Vater
30
——— shows filling defects in ——— (blue arrow) and ——— (red arrow)
- Cholangiography
- gallbladder
- common bile
31
Gallstones that reach the confluence of the ——— and ——— at the ampulla of Vater can block both (called the ———), causing both ——— and ———, respectively
- common bile duct
- pancreatic duct
- double duct sign
- cholangitis
- pancreatitis
32
Tumors that arise in head of pancreas (usually ———) can cause obstruction of ——— duct enlarged ——— with symptom of ——— (called ———)
- ductal adenocarcinoma
- common bile
- gallbladder
- painless jaundice
- Courvoisier sign
33
List the 4 layers of gut wall and their key components/functions (inside to outside):
MSMS:
- Mucosa—epithelium, lamina propria, muscularis mucosa
-Submucosa—includes Submucosal nerve plexus (MeiSSner), Secretes fluid
- Muscularis externa—includes Myenteric nerve plexus (Auerbach), Motility
- Serosa (when intraperitoneal), adventitia (when retroperitoneal)
34
How far can ulcers vs erosions extend into layers of gut wall?
- Ulcers can extend into submucosa, inner or outer muscular layer
- Erosions are in mucosa only
35
List the frequency of basal electric rhythm (slow waves), which originate in the ———, relative to the stomach, duodenum, and ileum:
- interstitial cells of Cajal
- duodenum > ileum > stomach
36
Source and action of gastric acid?
Source: Parietal cells (stomach)
Action: Decrease stomach pH
37
Source and action of intrinsic factor?
Source: Parietal cells (stomach)
Action: Vitamin B12–binding protein (required for B12 uptake in terminal ileum)
38
Regulation in terms of increasing or decreasing gastric acid and intrinsic factor by?
Increased by: histamine, vagal stimulation (ACh), gastrin
Decreased by: somatostatin, GIP, prostaglandin, secretin
39
Autoimmune destruction of parietal cells can result in what 2 conditions:
chronic gastritis and pernicious anemia
40
Source and action of pepsin?
Source: Chief cells (stomach)
Action: Protein digestion
41
Regulation in terms of increasing pepsin by?
Increased by: vagal stimulation (ACh), local acid
42
Pepsinogen (status:———) is converted to pepsin (status:———) in the presence of ———
- inactive
- active
- H+
43
Source and action of bicarbonate?
Source: Mucosal cells (stomach, duodenum, salivary glands, pancreas) and Brunner glands (duodenum)
Action: Neutralizes acid
44
Regulation in terms of increasing bicarbonate by?
Increased by pancreatic and biliary secretion with secretin
45
Bicarbonate is trapped in ——— that covers the gastric ———
- mucus
- epithelium
46
Gastrin ——— acid secretion primarily through its effects on ——— (leading to ——— release) rather than through its direct effect on ———
- increases
- enterochromaffin-like (ECL) cells
- histamine
- parietal cells
47
List the 3 key sites of portosystemic anastomoses:
1. Esophagus
2. Umbilicus
3. Rectum
(Varices of gut, butt, and caput (medusae) are commonly seen with portal hypertension)
48
Name the clinical sign and associated portal-systemic connection when portal hypertension impacts esophagus:
Clinical sign: Esophageal varices
Portal-systemic connection: Left gastric ↔ esophageal (drains into azygos)
49
Name the clinical sign and associated portal-systemic connection when portal hypertension impacts umbilicus:
Clinical sign: Caput medusae
Portal-systemic connection: Paraumbilical ↔ small epigastric veins (branches of inferior and superficial epigastric veins) of the anterior abdominal wall
50
Name the clinical sign and associated portal-systemic connection when portal hypertension impacts rectum:
Clinical sign: anorectal varices
Portal-systemic connection: Superior rectal ↔ middle and inferior rectal
51
Treatment with a ——— (TIPS) between the ——— and ——— relieves portal hypertension by shunting blood to ———, bypassing the ———
- Transjugular Intrahepatic Portosystemic Shunt
- portal vein
- hepatic vein
- the systemic circulation
- liver
52
TIPS can precipitate ——— due to decreased ——— from shunting.
- hepatic encephalopathy
- clearance of ammonia
53
Retroperitoneal structures are ———the peritoneal cavity; Injuries to retroperitoneal structures can cause ——— in retroperitoneal space
- posterior/outside
- blood or gas accumulation
54
List the Retroperitoneal structures:
SAD PUCKER:
- Suprarenal (adrenal) glands
- Aorta and IVC
- Duodenum (2nd through 4th parts)
- Pancreas (except tail)
- Ureters
- Colon (descending and ascending)
- Kidneys
- Esophagus (thoracic portion)
- Rectum (partially)
55
Cirrhosis results in diffuse bridging ——— (via ——— cells) and ——— disrupt normal architecture of liver
- fibrosis
- stellate
- regenerative nodules
56
Cirrhosis associated with increased risk for:
hepatocellular carcinoma
57
List 6 key etiologies of cirrhosis:
- alcohol
- nonalcoholic steatohepatitis
- chronic viral hepatitis
- autoimmune hepatitis
- biliary disease
- genetic/metabolic disorders
58
List 3 key etiologies of portal hypertension (pressure in portal venous system):
- cirrhosis (most common cause in developed countries)
- vascular obstruction (eg, portal vein thrombosis, Budd-Chiari syndrome),
- schistosomiasis
59
SAAG (full name: ———) refers to the difference between ——— (I.e., SAAG = ———)
- Serum ascites albumin gradient
- albumin levels in serum and ascitic fluid
- albumin serum – albumin ascites
60
SAAG is used to evaluate the ———, with SAAG ≥ 1.1 = ——— and SAAG < 1.1 = ———
- etiology of ascites
- portal hypertension
- consider other causes
61
List 5 Integumentary symptoms of cirrhosis:
- Jaundice
- Spider angiomas*
- Palmar erythema*
- Purpura
- Petechiae
(*Due to elevated estrogen)
62
List 2 Neurologic symptoms of cirrhosis:
- Hepatic encephalopathy
- Asterixis (”flapping tremor”)
63
List 2 effects of portal hypertension as part of cirrhosis:
Esophageal and gastric varices (hematemesis/ melena)
64
List 4 vascular symptoms of cirrhosis:
- Caput medusae
- Anorectal varices
- Ascites
- Spontaneous bacterial peritonitis
65
List 3 Reproductive symptoms of cirrhosis:
- Testicular atrophy*
- Gynecomastia*
- Amenorrhea
(*Due to elevated estrogen)
66
List 4 GI symptoms of cirrhosis:
- Anorexia
- Nausea, vomiting
- Dull abdominal pain
- Fetor hepaticus
67
List 4 Hematologic symptoms of cirrhosis:
- Thrombocytopenia
- Anemia
- Coagulation disorders
- Splenomegaly
68
List 1 renal symptom of cirrhosis:
Hepatorenal syndrome
69
List 2 Metabolic symptoms of cirrhosis:
- Hyperbilirubinemia
- Hyponatremia
70
List 2 Cardiovascular symptoms of cirrhosis:
- Cardiomyopathy
- Peripheral edema
71
Spontaneous bacterial peritonitis (also called ———) is a common and potentially fatal bacterial infection in patients with ———
- 1° bacterial peritonitis
- cirrhosis and ascites
72
In terms of symptoms, spontaneous bacterial peritonitis often presents with ———, but can also cause —(list 5 symptoms)—
- asymptomatic
- fevers, chills, abdominal pain, ileus, or worsening encephalopathy
73
Spontaneous bacterial peritonitis is commonly caused by ——— or less commonly ———
- gram ⊝ organisms (eg, E coli, Klebsiella)
- gram ⊕ Streptococcus
74
Spontaneous bacterial peritonitis is diagnosed with ———, and empiric first-line treatment is ———
- paracentesis with ascitic fluid absolute neutrophil count (ANC) > 250 cells/mm3
- 3rd generation cephalosporin (eg, ceftriaxone)
75
Appendicitis refers to ——— that can be due to obstruction by ——— (in adults) or ——— (in children)
- acute inflammation of the appendix
- fecalith
- lymphoid hyperplasia
76
Appendicitis can occur with proximal obstruction of appendiceal lumen leading to ——— obstruction with increased ——— and stimulation of ——— at ——— resulting in initial diffuse ——— pain with potential for inflammation extends to ——— and irritate ———
- closed-loop
- intraluminal pressure
- visceral afferent nerve fibers
- T8-T10
- periumbilical
- serosa
- parietal peritoneum
77
In appendicitis, the pain is localized to———, specifically ——— point (located: ———)
- RLQ
- McBurney point
- 1/3 the distance from right anterior superior iliac spine to umbilicus
78
Along with pain, appendicitis can present with —(list 3)—; may perforate causing ———
- nausea, fever, guarding and rebound tenderness on exam
- peritonitis
79
Appendicitis may elicit what 3 signs:
- psoas = With the patient in the left lateral decubitus position, extension of the right hip increases pain in the right lower quadrant (when an inflamed appendix is overlying the right psoas muscle)
- obturator = With the patient in the supine position, internal rotation of a passively flexed right hip and knee increases right lower quadrant pain
- Rovsing = severe RLQ pain with palpation of LLQ
80
Treatment for Appendicitis:
appendectomy
81
Full name for AST and ALT?
Aspartate aminotransferase and alanine aminotransferase
82
In most liver disease: while both ———, ALT is ——— than AST; in alcoholic liver disease: while both ———, AST ——— than ALT (ratio usually ———)
- increased
- greater
- increased
- greater
- > 2:1 (AST does not typically exceed 500 U/L in alcoholic hepatitis)
(Make a toAST with alcohol AST > ALT)
83
If AST > ALT in nonalcoholic liver disease suggests:
progression to advanced fibrosis or cirrhosis
84
If aminotransferase levels very high (>1000 U/L) differential includes: (list 4)
- drug-induced liver injury (eg, acetaminophen toxicity)
- ischemic hepatitis
- acute viral hepatitis
- autoimmune hepatitis
85
List three conditions with elevated Alkaline phosphatase (ALP):
- cholestasis (eg, biliary obstruction)
- infiltrative disorders
- bone disease
86
γ-glutamyl transpeptidase is elevated in various ——— diseases (just as ——— can), but not in ——— disease (located in ——— of hepatocytes like ———); associated with ——— use
- liver and biliary
- ALP
- bone
- canalicular membrane
- ALP
- alcohol
87
List 2 causes of elevated Bilirubin:
- liver diseases (eg, biliary obstruction, alcoholic or viral hepatitis, cirrhosis)
- hemolysis
88
In advanced liver disease, Albumin may be ——— as it is a marker of ———
- decreased
- liver’s biosynthetic function
89
Prothrombin time is ——— in advanced liver disease; results from ———
- increased
- decreased production of clotting factors, thereby measuring the liver’s biosynthetic function
90
Platelets are ——— in advanced liver disease (as a result of decreased ——— and liver ———) and portal hypertension (resulting in ——— relative to the spleen)
- decreased
- thrombopoietin
- sequestration
- splenomegaly/splenic sequestration
91
Hepatic encephalopathy results when cirrhosis leads to ——— and subsequently decreased metabolism of ———; this results in symptoms of ——— dysfunction (—reversible or irreversible—) ranging from ——— to ———
- portosystemic shunts
- NH3
- neuropsychiatric
- reversible
- disorientation/asterixis
- difficult arousal or coma
92
Triggers for hepatic encephalopathy include:
- Increased NH3 production and absorption (due to GI bleed, constipation, infection)
- Decreased NH3 removal (due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS)
93
List 2 treatments for hepatic encephalopathy:
- lactulose (Increasing NH4 + generation)
- rifaximin (decreasing NH3 -producing gut bacteria)
94
Autoimmune hepatitis is a ——— liver disease that is more common in ——— and present with: (list 4)
- chronic inflammatory
- females
- asymptomatic or presents with fatigue, nausea, pruritus
95
Autoimmune hepatitis is often ⊕ for ——— or ——— antibodies.
Labs: increased ———
Histology: ——— infiltrate
- anti-smooth muscle
- anti-liver/kidney microsomal-1
- ALT and AST
- portal and periportal lymphoplasmacytic
96
Describe the three major histological findings associated with alcoholic liver disease:
- Hepatic steatosis
- Alcoholic hepatitis
- Alcoholic cirrhosis
97
In alcoholic liver disease, hepatic steatosis on histology shows ——— that may be reversible with ———
- macrovesicular fatty change
- alcohol cessation
98
Alcoholic hepatitis requires ———, and on histology shows ——— hepatocytes with ——— infiltration; as well as ——— bodies (which are ———)
- sustained, long-term consumption
- swollen and necrotic
- neutrophilic
- Mallory bodies (see below)
- intracytoplasmic eosinophilic inclusions of damaged keratin filaments
99
Alcoholic cirrhosis is the ——— form of alcoholic liver disease, with histology demonstrating sclerosis around ——— in early disease; Regenerative nodules surrounded by ——— in response to chronic liver injury, leading to ——— and end-stage liver disease
- final and usually irreversible
- central vein
- fibrous bands (see image below)
- portal hypertension
100
Nonalcoholic fatty liver disease is associated with ———, which includes —(list 5)—
- metabolic syndrome
- obesity, insulin resistance, HTN, hypertriglyceridemia, decreased HDL
101
In nonalcoholic fatty liver disease, obesity leads to ——— of hepatocytes which then yields cellular ——— and eventual ———
- fatty infiltration
- “ballooning”
- necrosis
102
In nonalcoholic fatty liver disease, steatosis present without evidence of significant ———-; May ——— over time
- inflammation or fibrosis
- persist or even regress
103
Nonalcoholic steatohepatosis is associated with lobular ——— and hepatocyte ——— leading to ———; May progress to ———
- inflammation
- ballooning
- fibrosis
- cirrhosis and HCC
104
Budd-Chiari syndrome occurs when there is a ——— (eg, due to ———)
- hepatic venous outflow tract obstruction
- thrombosis, compression
105
Budd-Chiari syndrome yields ——— congestion and necrosis leading to congestive liver disease, with symptoms of —(list 5)—; Absence of —(list 1 syptom)—
- centrilobular
- hepatomegaly, ascites, varices, abdominal pain, liver failure
- JVD
106
Budd-Chiari syndrome is associated with what 4 conditions/states:
hypercoagulable states
polycythemia vera
postpartum state
HCC
107
Portal vein thrombosis refers to:
thrombosis in portal vein proximal to liver
108
Portal vein thrombosis usually presents with ———in the majority of patients, but associated with —(list 3 syptoms)—; May lead to ——— if extension to ——— vein
- asymptomatic
- portal hypertension, abdominal pain, fever
- bowel ischemia
- superior mesenteric
109
Portal vein thrombosis etiologies include: (list 4)
cirrhosis
malignancy
pancreatitis
sepsis
110
Reye syndrome is a rare, often fatal childhood ———; Associated with ———(especially ———) that has been treated with ———
- hepatic encephalopathy
- viral infection
- VZV and influenza
- aspirin
111
In terms of causes for Reye syndrome, aspirin metabolites decrease ——— by reversible inhibition of ———
- β-oxidation
- mitochondrial enzymes
112
List 7 findings in Reye syndrome:
- mitochondrial abnormalities
- fatty liver (microvesicular fatty changes)
- hypoglycemia
- vomiting
- hepatomegaly
- coma
- Renal and cardiac failure may also occur
(Requires expert review)
113
In Reye syndrome, increased ———leads to increased morbidity and mortality
ICP
114
Due to Reye Syndrome, avoid aspirin in children, except in ———disease
KawASAki
(Note: aspirin = ASA)
115
Define mnemonic: Salicylates aren’t a ray (Reye) of sunSHINE for kids:
Steatosis of liver/hepatocytes
Hypoglycemia/Hepatomegaly
Infection (VZV, influenza)
Not awake (coma)
Encephalopathy
116
List 3 causes of sludge or stones in the gallbladder:
Increased cholesterol and/or bilirubin
Decreased bile salts
Gallbladder stasis
117
List the 2 types of Cholelithiasis:
Cholesterol stones
Pigment stones
118
Cholesterol stones on imaging are usually ——— with 10–20% being ——— due to ———
- radiolucent
- opaque
- calcifications
119
Cholesterol stones are associated with what 8 factors:
obesity
Crohn disease
advanced age
estrogen therapy
multiparity
rapid weight loss
medications (eg, fibrates)
race (increased incidence in White and Native American populations)
120
Pigment stones that are black are ——— on imagining and are composed of ——— related to ———; and pigment stones that are brown are ——— on imagining and are related to ———
- radiopaque
- Ca2+ bilirubinate
- hemolysis
- radiolucent
- infection
121
Pigment stones are associated with what 6 factors:
Crohn disease
chronic hemolysis
alcoholic cirrhosis
advanced age
biliary infections
total parenteral nutrition (TPN)
122
Gallstones are diagnosed with ———, and treated with ——— if symptomatic
- ultrasound
- elective cholecystectomy
123
Most common complication of gallstones is ———; can also cause ——— and ———
- cholecystitis
- acute pancreatitis
- acute cholangitis
124
Are cholesterol or pigment gallstones more common?
cholesterol
(80% of stones)
125
Risk factors for gallstones (5 F’s):
female
fat (obesity)
fertile (multiparity)
forty
fair
126
Biliary colic presents with what 2 symptoms: ———, and is associated with ——— activation (eg, ———) triggers ———, forcing ———
- symptoms: nausea/vomiting and dull RUQ pain
- neurohormonal
- by CCK after a fatty meal
- contraction of gallbladder
- stone into cystic duct
127
In biliary colic, labs show ———, ultrasound shows ———
- normal values
- cholelithiasis
128
Choledocholithiasis refers to the ———, often leading to elevated. —(list 4 lab values)—
- presence of gallstone(s) in common bile duct
- ALP, GGT, direct bilirubin, and/or AST/ALT
129
Cholecystitis refers to:
Acute or chronic inflammation of gallbladder
130
Calculous cholecystitis is due to ——— resulting in ———; can produce 2°———
- gallstone impaction in the cystic duct
- inflammation and gallbladder wall thickening (arrows in picture)
- infections
131
Acalculous cholecystitis is due to —(list 3)—; seen in ——— patients
- gallbladder stasis, hypoperfusion, or infection (CMV)
- critically ill
132
What is more common Calculous or Acalculous cholecystitis?
Calculous cholecystitis
133
Murphy sign refers to:
inspiratory arrest on RUQ palpation due to pain
134
With Murphy sign (inspiratory arrest on RUQ palpation due to pain), pain may radiate to ——— (due to irritation of ——— nerve)
- right shoulder
- phrenic
135
With Cholecystitis, labs will show elevated ——— if ——— becomes involved (eg, ———)
- ALP
- bile duct
- acute cholangitis
136
Cholecystitis is diagnosed with ——— or ———; Failure to visualize gallbladder on scan suggests ———
- ultrasound
- cholescintigraphy (hepatobiliary iminodiacetic acid; HIDA scan)
- obstruction
137
Gallstone ileus presents with ——— triad, which radiographic findings of what 3 things:
- Rigler
- pneumobilia, small bowel obstruction, gallstone (usually in iliac fossa)
138
Gallstone ileus is a ———, in which a stone enters ———obstructs at ——— (narrowest point); can see ——— in biliary tree (I.e., ———)
- fistula between gallbladder and GI tract
- GI lumen
- ileocecal valve
- air
- pneumobilia
139
Porcelain gallbladder is a ——— gallbladder due to ———; usually found ———
- calcified
- chronic cholecystitis
- incidentally on imaging
140
Porcelain gallbladder is treated with ———, generally recommended due to risk of ———
- prophylactic cholecystectomy
- gallbladder cancer (mostly adenocarcinoma)
141
Acute cholangitis (also called ———) refers to an ——— usually due to ——— that leads to ———
- ascending cholangitis
- infection of biliary tree
- obstruction
- stasis/bacterial overgrowth
142
Acute cholangitis can lead to ———triad of cholangitis including:
- Charcot
- jaundice, fever, RUQ pain
143
Acute cholangitis can lead to ———pentad, which is Charcot triad plus ———
- Reynolds
- altered mental status and shock (hypotension)
