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T2 - Phase 2 - Systems Modules (III) > GI - Biliary Disease; Pancreatic Disease > Flashcards

GI - Biliary Disease; Pancreatic Disease Flashcards

1
Q

What does ERCP stand for in biliary tree examination?

A

Endoscopic retrograde cholangiopancreatography

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2
Q

__________ refers to impairment of bile flow (and resultant accumulation in hepatic parenchyma).

A

Cholestasis refers to impairment of bile flow (and resultant accumulation in hepatic parenchyma).

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3
Q

__________ refers to biliary tree infection.

A

Cholangitis refers to biliary tree infection.

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4
Q

__________ refers to gallstone formation in the biliary tree.

A

Choledocholithiasis refers to gallstone formation in the biliary tree.

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5
Q

RBC heme is converted to unconjugated bilirubin via what two enzymes?

A

Heme oxygenase

+

Biliverdin reductase

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6
Q

Bilirubin is hydro______ and carried to the liver by _________.

A

Bilirubin is hydrophobic and carried to the liver by albumin.

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7
Q

In the liver, bilirubin is conjugated with ___________ and secreted into bile (to enter the gut).

A

In the liver, bilirubin is conjugated with glucuronides and secreted into bile (to enter the gut).

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8
Q

This slide shows hepatic changes due to what form of cholestasis?

A

Mechanical obstruction

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9
Q

This slide shows hepatic changes due to what form of cholestasis?

A

Intrahepatic stasis

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10
Q

What non-acetominophen drug is especially associated with hepatic injury which potentially leads to intrahepatic cholestasis?

A

Amoxicillin - clavulinic acid

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11
Q

What severe genetic syndrome leads to an increase in serum unconjugated bilirubin?

What mild genetic syndrome leads to an increase in serum unconjugated bilirubin?

A

Crigler-Najjar syndrome

Gilbert’s syndrome

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12
Q

What severe genetic syndrome leads to an increase in serum conjugated bilirubin?

What mild genetic syndrome leads to an increase in serum conjugated bilirubin?

A

Dubin-Johnson syndrome

Rotor’s syndrome

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13
Q

Primary biliary cholangitis is most commonly seen in what demographic?

A

Middle-aged women

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14
Q

Primary biliary cholangitis is a(n) ___________ (etiology) disease most affecting the _______ (size or extent) biliary ducts.

A

Primary biliary cholangitis is an autoimmune disease most affecting the small biliary ducts.

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15
Q

What serum factors are elevated in cases of primary biliary cholangitis?

A

Anti-mitochondrial antibody

ALP

ANA

Bilirubin

ALT/AST

Cholesterol

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16
Q

Which is associated with xanthelasmas, primary biliary cholangitis or primary sclerosing cholangitis?

A

Primary biliary cholangitis

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17
Q

What are the three components of treatment for primary biliary cholangitis?

A

Ursodeoxycholic acid (a naturally-occurring bile acid),

alendronate (a bisphosphonate),

Ca2+

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18
Q

The diagnostic criteria for primary biliary cholangitis is 2/3 of the following:

1.

2.

3.

A

The diagnostic criteria for primary biliary cholangitis is 2/3 of the following:

  1. ANA-positive
  2. Cholestasis
  3. Suggestive liver biopsy
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19
Q

Primary biliary cholangitis most affects the ______hepatic ducts.

A

Primary biliary cholangitis most affects the intrahepatic ducts.

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20
Q

Describe the histological appearance of primary biliary cholangitis.

A

‘Jigsaw’ fibrosis;

granulomas surrounding hepatic portal ducts (extra-hepatic ducts normal)

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21
Q

Primary sclerosing cholangitis is most commonly seen in what demographic?

A

Middle-aged men

(2:1)

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22
Q

Primary sclerosing cholangitis is a(n) ___________ (etiology) disease most affecting the _______ (size or extent) biliary ducts.

A

Primary sclerosing cholangitis is an autoimmune disease most affecting the large biliary ducts.

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23
Q

What serum factors are elevated in cases of primary sclerosing cholangitis?

A

ALP

Bilirubin

(ANA-negative!)

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24
Q

Which is ANA-negative, primary biliary cholangitis or primary sclerosing cholangitis?

A

Primary sclerosing cholangitis

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25
Q

Which affects the intrahepatic ducts only, primary biliary cholangitis or primary sclerosing cholangitis?

A

Primary biliary cholangitis

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26
Q

Which can affect both the extrahepatic and intrahepatic ducts, primary biliary cholangitis or primary sclerosing cholangitis?

A

Primary sclerosing cholangitis

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27
Q

What are the S/Sy and features of primary sclerosing cholangitis?

A

Pruritus, fatigue, episodic jaundice, abdominal pain;

concomitant ulcerative colitis

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28
Q

Which is associated with ulcerative colitis, primary biliary cholangitis or primary sclerosing cholangitis?

A

Primary sclerosing cholangitis

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29
Q

How is primary sclerosing cholangitis diagnosed?

A

Liver biopsy + ERCP

(endoscopic retrograde cholangiopancreatography)

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30
Q

How will the biliary tree appear on ERCP in patients with primary sclerosing cholangitis?

A

‘Pearl necklace’ strictures;

onion skinning possible

31
Q

What is the prognosis for primary sclerosing cholangitis?

A

It is progressive and incurable

32
Q

Primary sclerosing cholangitis is associated with c___________, recurrent b_________, and g__________.

A

Primary sclerosing cholangitis is associated with cholangiocarcinoma, recurrent bacteremia, and gallstones.

33
Q

What is the name for any biliary fibrosis / cirrhosis due to large duct trauma or extrahepatic obstruction by causes other than primary biliary sclerosis?

A

Secondary biliary sclerosis/cirrhosis

34
Q

What is the term used to describe cysts of the biliary tree?

A

Choledochoceles

(choledochal cysts)

35
Q

What is the term used to describe stone deposition in the gallbladder?

A

Cholelithiasis

36
Q

A type ____ choledocholcele (a congeital biliary tree dilatation) protrudes into the duodenum.

A

A type III choledocholcele (a congeital biliary tree dilatation) protrudes into the duodenum.

37
Q

What are some of the possible S/Sy of a choledochal cyst (choledocholcele)?

A

Abdominal pain,

jaundice,

palpable mass

38
Q

Name the three most common infectious causes of cholangitis in descending order of occurrence.

A

Enterococci spp.

>

E. coli

>

Klebsiella spp.

39
Q

Name a few etiologies of bile stasis that might lead to cholangitis.

A

Choledocholithiasis;

benign strictures;

malignancy;

choledochoceles

40
Q

What are the three points of Charcot’s triad of cholangitis?

A

Fever, pain, jaundice

41
Q

Reynaud’s pentad of cholangitis includes what two factors besides Charcot’s (fever, jaundice, and pain)?

A

Confusion,

hypotension

42
Q

Describe the elevated serological features of cholangitis.

A

AST and ALT,

ALP,

bilirubin

43
Q

How is cholangitis treated?

A

Ciprofloxacin

(or another fluoroquinolone)

44
Q

Choledocholithiasis is more common in which gender?

A

Females

(2:1)

45
Q

What are the four ‘F’s of choledocholithiasis?

A

Fat, fertile females over forty

46
Q

Describe the gross appearance and character of cholesterol gallstones.

A

White, tough

47
Q

Describe the gross appearance and character of pigment gallstones.

A

Black, crushable

48
Q

How does choledocholithiasis typically present?

A

Asymptomatically

49
Q

If asymptomatic, how does choledocholithiasis typically present?

A

Typically a sharp, colicky pain in RUQ or epigastric regions

(sometimes associated with fatty food intake)

50
Q

A patient with cholecystitis presents with a positive Murphy’s sign. What happened when you compressed her gallbladder?

A

She stopped breathing

51
Q

Name two fairly intense complications of choledocholithiasis.

A

Pancreatitis;

cholangitis

52
Q

Do serum liver enzymes change with choledocholithiasis?

A

They can

(may be normal or abnormal)

53
Q

How are gallstones typically diagnosed?

A

Ultrasound

or

ERCP

54
Q

Gallbladder malignancies are ______ (frequency) and almost always ___________ (type).

A

Gallbladder malignancies are very rare and almost always adenocarcinomas.

55
Q

Gallbladder malignancies are associated with chronic __________ and/or __________.

A

Gallbladder malignancies are associated with chronic inflammation and/or infection.

56
Q

What infections are associated with development of gallstone malignancies?

A
  • Helicobacter pylori*
  • Salmonella typhi*
57
Q

Which is more common, gallbladder malignancies or cholangiocarcinomas?

(I.e. which is more common, malignancies of the gallbladder or the biliary tree?)

A

Gallbladder malignancies

58
Q

What is the term for an abberrant portion of pancreatic tissue found somewhere in the GI tract?

A

A pancreatic rest

59
Q

True/False.

Pancreatic divisum (split pancreas) is fairly common and fairly benign.

A

True.

60
Q

An annular pancreas can form via what process?

A

The natural rotation of the duodenum during development

61
Q

Name two complications that an annular pancreas can cause.

A

Duodenal strictures;

pancreatitis

62
Q

Name the two most common causes of pancreatitis and give the percentage of cases for which each is responsible.

A

Gallstones (40%);

alcohol (40%)

63
Q

Autoimmune pancreatitis is associated with increased levels of serum _______.

A

Autoimmune pancreatitis is associated with increased levels of serum IgG4.

64
Q

Pancreatitis is associated with _____calcemia.

A

Pancreatitis is associated with hypercalcemia (due to errant in-pancreas activation of pancreatic enzymes by calcium).

65
Q

What is the main cause of ‘hereditary pancreatitis?’

A

Cystic fibrosis

66
Q

What is the typical clinical presentation of pancreatitis?

A

Mid-epigastric pain through the back;

umbilical or back bruising may be present

67
Q

What lab values are indicative of pancreatitis?

A

Elevated serum amylase and lipase

68
Q

Name some of the many possible complications of pancreatitis.

A

Duodenal obstruction;

bile duct stricture;

gastric varices;

pseudoaneurysms

splenic rupture

69
Q

What are the components of treating pancreatitis?

A

Rest the pancreas;

antacids + oral pill of pancreatic enzymes;

pain management

70
Q

Why is it useful to treat pancreatitis with oral pills of pancreatic enzymes?

A

Subsequent downregulation of secretin and pancreatic enzyme secretion

71
Q

Pancreatic cysts may be congenital.

Pancreatic pseudocysts are more associated with what processes?

A

Inflammation (pancreatitis) or neoplasia (e.g. serous or mucinous cystadenomas)

72
Q

What is the most common sign of pancreatic malignancy?

A

Painless jaundice

73
Q

Pancreatic malignancies are typically __________ (type) and present at a(n) _______-stage (early/mid/late).

A

Pancreatic malignancies are typically adenocarcinomas and present at a late-stage.

T2 - Phase 2 - Systems Modules (III) (14 decks)

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