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PANCE 2.0 > GI #1 > Flashcards

GI #1 Flashcards

1
Q

What is cholelithiasis?

A

Gallstones in the biliary tract (without inflammation)

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2
Q

MC type of cholelithiasis?

A

Cholesterol

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3
Q

However, what type of gallstone is MC in ETOH-related cirrhosis and which type is MC in Asian population?

A

ETOH: black stones
Asian: brown stones

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4
Q

Risk factors for cholelithiasis

A
  • Fat
  • Fair skin
  • Female
  • Forty
  • Fertile
  • OCPs (increased estrogen)
  • Native Americans
  • Rapid weight loss
  • IBD
  • Increased triglycerides
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5
Q

Symptoms of cholelithiasis

A

-Most asymptomatic

  • Biliary colic, abrupt RUQ pain (lasts 30 minutes to hours)
  • Nausea precipitated by fatty foods or large meals
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6
Q

What is the initial test of choice for cholelithiasis?

A

US

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7
Q

If the gallstone is asymptomatic, observation is the management of choice. However, what can also be used to dissolve the stones and how long does it take?

A

Ursodeoxycholic acid (takes 6-9 months)

Elective cholecystectomy if symptomatic

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8
Q

When the gallstone becomes lodged and obstructs the cystic duct, infection and inflammation occurs, which is called?

A

Acute cholecystitis

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9
Q

What is the MC infection in acute cholecystitis?

A

E. coli

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10
Q

Clinical manifestations of acute cholecystitis

A
  • Continuous RUQ or epigastric pain (may be associated with large or fatty meals)
  • Nausea, anorexia, guarding
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11
Q

Physical exam findings associated with cholecystitis

A
  • Fever, enlarged palpable gallbladder
  • Murphy’s Sign: inspiratory arrest with palpation of gallbladder
  • Boas sign: right shoulder pain
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12
Q

Explain the cause of Boas sign with cholecystitis

A

-Phrenic nerve irritation

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13
Q

The initial test for cholecystitis is ______ whereas the gold standard is _____

A

US

HIDA scan (cholescintigraphy)

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14
Q

Management for cholecystitis

A
  • NPO
  • IVF
  • ABX (Ceftriaxone + Metronidazole)
  • Followed by cholecystectomy
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15
Q

If the patient is nonoperative, what should be done for cholecystitis?

A

-Cholecystostomy (percutaneous drainage of the gallbladder)

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16
Q

What is acute acalculous cholecystitis?

A

-Necroinflammatory disease of the gallbladder not due to gallstones

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17
Q

What is choledocolithiasis?

A

Gallstones in the common bile duct

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18
Q

Symptoms of choledocolithiasis

A
  • Prolonged biliary colic (more prolonged due to stone blocking bile duct)
  • RUQ Pain
  • Jaundice
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19
Q

Labs for choledocolithiasis

A
  • Labs: elevated AST and ALT

- Increased Alkaline phosphatase + GGT (cholestasis)

20
Q

What diagnostics are done for choledocolithiasis?

A
  • US (initial)

- ERCP (diagnostic of choice) because is diagnostic and therapeutic

21
Q

Treatment for choledocolithiasis

A

-ERCP stone extraction

22
Q

Cholangitis is

A

biliary tract infection secondary to obstruction of the common bile duct

23
Q

Symptoms of cholangitis

A
  • Charcot’s Triad: fever + RUQ Pain + Jaundice

- Reynold’s Pentad: + Hypotension/Shock + AMS

24
Q

Diagnostics for cholangitis

A
  • Labs: Leukocytosis, increased alkaline phosphatase + GGT
  • US (initial)
  • MRCP (Most accurate)
  • Cholangiography (gold standard via ERCP)
25
Q

Treatment for cholangitis

A
  • IV ABX followed by CBD decompression and stone extraction once stable
  • ERCP
26
Q

When should ERCP for cholangitis be done?

A

Once patient has been afebrile/stable for 48 hours after IV ABX

27
Q

What population is at increased risk for neonatal jaundice?

A

Asian population

28
Q

When does neonatal jaundice present and when should it normalize?

A

Presents on days 3-5 of life and bilirubin levels fall in about 50% of neonates during the first week of life

29
Q

Jaundice, yellowing of the skin, is associated with bilirubin levels of

A

> 5.0 mg/dL

30
Q

What is kernicterus and what levels of bilirubin is it associated with?

A
  • Cerebral dysfunction and encephalopathy (lethargy, hearing loss, mental developmental delays)
  • Bilirubin > 20 mg/dL
31
Q

What is the initial therapy of choice for neonatal jaundice?

A

Phototherapy

32
Q

Phototherapy is initiated based on age. Explain this.

A

24 hours of age > 12 mg/dL
48 hours of age > 15 mg/dL
72 hours of age > 18 mg/dL

33
Q

In severe cases of neonatal jaundice, what treatment is done?

A

Exchange transfusion

34
Q

What is Dubin-Johnson Syndrome?

A

Isolated conjugated (direct) hyperbilirubinemia

35
Q

On liver biopsy, what is seen with Dubin-Johnson Syndrome?

A

Grossly black liver and dark pigment in hepatocytes

36
Q

What is Rotor’s Syndrome and how is it different from Dubin-Johnson Syndrome?

A

Associated with conjugated and unconjugated hyperbilirubinemia
-Not associated with grossly black liver on biopsy

37
Q

What is Crigler-Najjar Syndrome?

A

Hereditary unconjugated hyperbilirubinemia

38
Q

What is the pathophysiology of Crigler-Najjar Syndrome?

A

-Decreased activity of the UGT enzyme needed to convert indirect bilirubin to direct bilirubin

39
Q

What are the symptoms of Crigler-Najjar Syndrome?

A
  • Neonatal Jaundice with severe progression in second week leading to kernicterus
  • Or asymptomatic
40
Q

How to diagnose Crigler-Najjar Syndrome?

A

-Labs: Isolated (indirect) unconjugated hyperbilirubinemia and otherwise normal liver function tests

41
Q

What is the treatment of choice for Crigler-Najjar Syndrome?

A

Phototherapy (if no UGT activity) and Phenobarbital (if very little UGT activity)

42
Q

What is the enzyme responsible for conjugation of bilirubin?

A

UGT (glucuronosyltransferase)

43
Q

What is Gilbert’s Syndrome?

A

-Reduced UGT activity and transient episodes of jaundice during periods of stress, fasting, alcohol, or illness

44
Q

What findings are on labs for Gilbert’s Syndrome?

A

-Increase in isolated indirect bilirubin level with otherwise normal LFTs

45
Q

Is PT or albumin an earlier indicator of severe liver injury/prognosis?

A

PT

46
Q

Prolonged PT is seen when _____% of the liver’s protein synthesizing ability is lost

A

80%

PANCE 2.0 (62 decks)

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