Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI2 > GB > Flashcards

GB Flashcards

1
Q

GB - Duodenum path

A 
Cystic Duct 
Common Hepatic Duct  
Common Bile Duct 
Pancreatic Duct 
Duodenum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ampulla of vater location + fxn

A

between the pancreatic duct and the duodenum

`Controls the flow of bile and pancreatic juices via the sphincter of Oddi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • Bilirubin is formed by
A

breakdown of heme in hemoglobin, myoglobin

Poorly soluble in water
unbound = toxic to nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where does bilirubin become conjugate

A

in liver via glucuronidation

combined with lecithin and cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

bile composition

A

Detergent like substance that contains cholesterol, lecithin, bile acids, conjugated bilirubin and protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

bile stored + stimulus

A

GB

released in response to CCK and vagal stimulation when food enters duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

bile fxn (3)

A

Facilitate fat digestion and absorption

Alkalinize acidic gastric chyme

Facilitates absorption of fat soluble vitamins (A, D, E, K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

BILE ACIDS metabolism

A

Pass thru small intestine and are actively reabsorbed in the terminal ileum and returned to liver via enterohepatic circulation

Re-conjugated and re-excreted by hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

risk factors for gall stone formation

A

5 Fs

Female
Forty 
Fat (high fat diet/obese) 
Fertile (multiple pregnancies)
Family history

ALSO: crohn’s/ileum resection, TPN, DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pathophys of cholelithiasis

A

Increase biliary cholesterol saturation = estrogen, obesity and rapid weight loss

Nucleation= increased by bacterial infection of biliary system, ABX (Ceftriaxone) and TPN

Biliary stasis 2/2 TPN, pregnancy, fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cholesterol Stones:

A

supersaturation of cholesterol causes cholesterol to precipitated out of solution

YELLOW cholesterol stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cause of Cholesterol Stones:

A

GB hypomotility and diets high in cholesterol will contribute to this process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bilirubin Stones:

A

too much bilirubin secreted,

BLACK stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

causes of bilirubin stones

A

Hemolytic anemia (G6PD, Spherocytosis, Sickle Cell anemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

infected Stones: color + location

A

BROWN stones, infected bile, soft;

MC found in cystic and common bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Biliary Sludge:

A

thick mucous in the GB that is a precursor to gall stones

mucous + proteins +cholesterol crystals + calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

biliary sludge

Associated with

A

TPN, rapid weight loss, starvation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

chronic cholecystitis AKA

A

biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

biliary colic path

A

pain when gallstone lodges in cystic duct causing increasing tension in GB that is later relieved

Causes GB hypertrophy, inflammation and eventual atrophy/fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

biliary colic epidemiology + risk factors

A

65% of symptomatic gall stone dz

fatty meals, preexisting dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

clinical présentation chronic cholecystitis

A

quick, rapid onset of pain in RUQ/epigastrium

***pain free after 1-4 hrs

+/-Bloating, belching, flatulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

chronic cholecystitis w/u

A

U/S RUQ

Labs are normal

MUST consider different diagnosis IF atypical presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

chronic cholecystitis tx

A

elective laparoscopic Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

management before sx for biliary colic + timing

A

Avoid fatty foods and large meals

DM should not wait long bc prone to complications

Pregnant women can undergo lap chole in 2nd trimester if diet fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute Cholecystitis

Pathophysiology:

A

stone becomes lodged in cystic duct causing a significant inflammatory response and mucosal thickening with sub serosal hemorrhage of GB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Acute Cholecystitis

Epidemiology + RF

A

95% due to gallstones, 5% caused by acalculous cholecystitis

hx of biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Acute Cholecystitis Clinical presentation

A

typical colic symptoms

pain doesn’t subside after 1-5 hours and lasts several days if untx

Pain more severe than usual colic

Febrile and systemically ill with anorexia, n/v

Pain located in RUQ, Murphy’s sign positive

Guarding and rebound tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Acute Cholecystitis Work-up:

A

CBC, Liver panel, RUQ u/s, HIDA scan

LEUKOCYTOSIS (12-15k, >20k suggests perforation(

Mild elevation in bilirubin, rest of liver panel is WNL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Acute Cholecystitis Complications:

A

bacterial contamination of bile, acute gangrenous cholecystitis = GB abscess or GB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Acute Cholecystitis tx (medical)

A

IVF

ABX (GN and anaerobic coverage – Rocephin + flagyl, unasyn, zosyn)

pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Acute Cholecystitis tx (sx)

Pt presents w/in first few days of illness:

A

Laparoscopic cholecystectomy within 24hrs

32
Q

Acute Cholecystitis tx (sx)

Pt presents >3-4 days after onset:

A

IVF, ABX, pain control, lap chole in 8 weeks

33
Q

Acute Cholecystitis tx (sx)

Pt not a surgical candidate:

A

percutaneous cholecystostomy to drain infected GB

34
Q

Ascending Cholangitis
Pathophysiology:
Epidemiology:

A

older, female

ascending bacterial infection of bile 2/2 biliary stasis and ascending infection from duodenum

35
Q

Ascending Cholangitis MC bacterial isolation (4)

A

o E. Coli
o Klebsiella
o Enterobacter
o Bacteroides

36
Q

Ascending Cholangitis RF

A

choledocholithiasis

37
Q

Ascending Cholangitis

clinical presentation

A

Charcot’s triad –> Reynold’s pentad

N/V, + murphy’s, RUQ pain with guarding

V clinically ill

38
Q

Charcot’s triad

A

RUQ pain, fever, jaundice

associated w/Ascending Cholangitis

39
Q

Reynold’s pentad

A

RUQ pain, fever, jaundice, septic shock, disorientation

associated w/Ascending Cholangitis

40
Q

Ascending Cholangitis

w/u

A

liver panel, ERCP

41
Q

ERCP in Ascending Cholangitis

A

determines level and type of obstruction,

placement of biliary stent

culture,

removal of obstruction

42
Q

Ascending Cholangitis

complications

A

: Gram negative septic shock

cardiac complications
renal failure
hepatic abscess

43
Q

Ascending Cholangitis Treatment:

A

ICU placement and IVF, ERCP

ERCP for removal of obstruction

44
Q

what if a. cholangitis pt is too sick for ERCP?

A

Decompression with cholesotomy and IV ABX

45
Q

Choledocholithiasis

Pathophysiology, Risk Factors

A

Gallstones within common bile duct

RF: increasing age

46
Q

Choledocholithiasis

clinical presentation

A

n/v, RUQ or epigastric pain and jaundice

47
Q

Choledocholithiasis

liver panel labs

A

elevated alkphos, bilirubin AND transaminase

48
Q

Choledocholithiasis test of choice

A

RUQ u/s

*unable to see stone due to bowel gas but can see dilated CBD

49
Q

Choledocholithiasis confirmed w? gold standard?

A

MRCP to confirm

ERCP = gold standard bc can tx and diagnose

50
Q

Choledocholithiasis Complications:

A

complete or incomplete CBD obstruction causing cholangitis or gallstone pancreatitis

51
Q

Choledocholithiasis tx

A

ERCP + lap chole

52
Q

Choledocholithiasis

Present and Known sx management

A

ERCP to remove stone followed by lap chole the next day

RF: pt could have stone that gets into different duct (retained ductal stone)

53
Q

Choledocholithiasis found during cholangiogram sx management

explore

A

exploration of duct and removal of CBD stone

RF: Dye can push stone down (to pancreatic duct, causing pancreatitis) = Susceptible to surgeon damage

54
Q

Choledocholithiasis found during cholangiogram sx management

complete

A

completion of cholecystectomy and ERCP to remove retained stones next day
o 2 procedures

55
Q

Acalculous Cholecystitis

patho + epi

A

acute inflammation of GB w/o gallstones

Epidemiology: critically ill patients

56
Q

Acalculous Cholecystitis w/u

A

liver panel u/s

57
Q

Acalculous Cholecystitis clinical presentation

A

fever, elevated WBC, increased alkaline phosphatase and bilirubin

58
Q

Acalculous Cholecystitis tx

A

Cholecystostomy (too ill for surgery)

59
Q

cholangiogram

A

Preformed during cholecystectomy to assess for ductal stones

Injection of contrast to look for filling defects and free flow contrast

If stones are found: there will be a blockage of contrast

60
Q

when would you do a cholangiogram

A

Significant change of biliary duct injury and subsequent stricture, bile leak, and need for biliary stent

61
Q

U/S RUQ

A

Diagnostic study of choice to look for stones/sludge

Demonstrates thickening of GB wall, pericholecystic fluid, sonographic Murphy’s sign

Looks for acoustic shadowing (sludge has none)

62
Q

HIDA scan

A

Evaluate for acute cholecystitis if RUQ u/s is non diagnostic

Injected IV and taken up selectively by hepatocytes and excreted into bile

picked up in response to CCK

63
Q

positive HIDA =

A

gallbladder does not visualize (due to cystic duct obstruction (edema associated with cholecystitis or obstructing stone)

Also positive if HIDA does not enter the small intestine

64
Q

Primary Biliary Cirrhosis

A

Autoimmune disorder causing immune mediated obliteration of SMALL/MEDIUM sized bile ducts in liver

Bile ducts are then destroyed and can no longer leave liver efficiently resulting in hepatitis in cirrhosis

65
Q

PBC presentation

A

Women in their 40s, debilitating fatigue and severe pruritus

Early: increased ALT, AST, elevated bilirubin and alk phos

Late: development of thrombocytopenia and prolonged PT/INR

AMA is in the serum of 95% of pts w/PBC

66
Q

PBC tx

A

ursodeoxycholic acid (slows progression in early phases)

liver transplant end stage dz

67
Q

PBC prognosis

A

development of sicca complex (dry eyes/mouth), RUQ pain, hyperpigmentation or jaundice, signs of cirrhosis

68
Q

Primary Sclerosing Cholangitis

A

Autoimmune process causing sclerosis of intra and extra-hepatic bile ducts of ALL SIZES, highly associated with IBD

69
Q

PSC presentation

A

fatigue, pruritus, RUQ pain, repeated bouts of ascending cholangitis

MC in men 20s-40s

Elevated alk phos and bilirubin in cholestatic pattern

Auto-immune Abs: p-ANCA, ANA

70
Q

tx of PSC

A

diagnosis confirmed with ERCP,

liver transplant, medical therapy ineffective

71
Q

prognosis of PSC

A

time from diagnosis to death is 12 yrs, associated with CCC development

72
Q

SURGICAL TREAMENT OF CHOICE

A

lap chole

due to reduced post op pain and LOS

73
Q

triangle of Calot

A

cystic duct inferiorly

common hepatic duct medially,

inferior visceral surface of liver superiorly

used in lap chole

74
Q

lap chole complications

A

increased pressure may cause internal organ injury

75
Q

indications for open chole

A

complications to lap chole

pregnant

76
Q

complications of open chole

A

increased infection
more pain
increased LOS

77
Q

Cholecystostomy

Indications:

A

percutaneous drain place to relieve distended, inflamed, or purulent GB when surgery is contraindicated

GI2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions