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Clinical Medicine III > GI: Biliary Diseases > Flashcards

GI: Biliary Diseases Flashcards

1
Q

The Four Fs of cholelithiasis…

A

female
fluffy
forty
fertile

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2
Q

MC presentation of cholelithiasis…

A

asymptomatic

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3
Q

Initial test of choice for cholelithiasis

A

US

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4
Q

What causes the pain in biliary colic?

A

pressure forcing stone against gallbladder

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5
Q

what disorder?

Intense RUQ, Epigastric Pain

+/- Radiation to Right Shoulder Blade

Constant and steady, lasts < 5-6 hours

Postprandial
N/V
Diaphoresis
Nocturnal pain

A

biliary colic

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6
Q

does movement make biliary colic worse?

A

no

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7
Q

is there jaundice, peritoneal signs, or murphy’s sign with biliary colic?

A

no

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8
Q

For biliary colic, US should show…

A

gallstones/sludge

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9
Q

When should tx be considered with asymptomatic gallstones?

A

when sxs develop, cholecystectomy

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10
Q

patient p/w…

Biliary colic
Normal PE
Normal CBC, LFTs, Amylase, Lipase

A

uncomplicated gallstone disease

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11
Q

gallbladder dysmotility…

A

functional gallbladder d/o

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12
Q

how is functional gallbladder d/o diagnosed?

A

exclusion + Rome IV criteria

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13
Q

What diagnostic should be ordered for suspected functional gallbladder d/o if no other causes can be considered…

A

CCK + HIDA scan

GBEF < 35%

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14
Q

Rome IV Criteria for functional gallbladder d/o…

A

Biliary pain
No stones
Low EF
Normal Labs

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15
Q

the below describes…

Lasts 30+ min
Not relieved w. BM, posture, antacids
Variable occurrence
Severe, interrupts daily life

A

biliary pain

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16
Q

When is cholecystectomy indicated in functional gallbladder d/o?

A

Biliary pain + GBEF < 40%

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17
Q

This is an acute inflammation of the GB +/- cystic duct obstruction

A

acute cholecystitis

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18
Q

Hx of:

Attack of worsening biliary pain ( > 4-6 hours steady, severe, RUQ/epigastric pain)

Fever

N/V, anorexia

Hx of fatty food

A

Acute cholecystitis

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19
Q

On PE…

laying still
(+) Murphy’s
(+) guarding
(+) RUQ TTP

A

acute cholecystitis

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20
Q

Labs should show ______ in acute cholecystitis

A

leukocytosis w/ left shift

+/- elevated AST/ALT

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21
Q

US shows + hx of biliary pain

Gallstones
Wall thickening
Pericholecystic fluid
Sonographic murphy’s sign

A

acute cholecystitis

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22
Q

When to order HIDA w. suspected acute cholecystitis

A

if dx uncertain

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23
Q

what is a POS for acute cholecystitis on HIDA scan?

A

failed gallbladder visualization

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24
Q

MC complication of acute cholecystitis (20%)

A

gangrene

25
Q

What is a serious, but rare, complication of acute cholecystitis that can cause jaundice?

A

Mirizzi Syndrome (impaction)

26
Q

Management of acute cholecystitis

A

admission for cholecystectomy + NPO, IV Fluids, IV pain meds (opioids), IV abx

27
Q

What disorder?

A/w gallstones

Minimal sxs

A

chronic cholecystitis

28
Q

What biliary disorder?

Acute inflammation w/o stones

High morbidity/mortality

Common w. Critically ill patients

A

acute acalculous cholecystitis

29
Q

Patient p/w

critically ill
sepsis w/o clear source
biliary pain
jaundice

A

Acute acalculous cholecystitis

30
Q

workup for biliary pain

A 
US
LFTs
CBC
CMP
Amylase
Lipase
UA
Urine Preg
31
Q

tx for acute acalculous cholecystitis

A

prompt Abx + blood Cx

32
Q

Patient p/w…

Prolonged Biliary Pain
Jaundice
Courvoisier Sign
normal vitals

A

choledocolithiasis

33
Q

What elevated LFTs indicate cholestasis?

A

serum bili
alk phos
GGt

34
Q

Labs in choledocolithiasis

A

cholestasis LFTs

35
Q

Management of choledocolithiasis

A

ERCP (therapeutic & Dx)

ID/tx of complications (acute cholangitis)

36
Q

what biliary d/o?

Bacterial infection in pt w. biliary obstruction

Ascent of bacteria from duodenum

“Pus under pressure” = surgical emergency

A

acute cholangitis

37
Q

Lab results suggesting acute cholangitis… (4)

A

leukocytosis w. left shift
elevated CRP/ESR
cholestatic LFTs
3x normal pancreatic enzymes

38
Q

What 2 things can be seen on MRCP/EUS in acute cholangitis?

A

CBD dilation, stone

39
Q

Charcot’s Triad for acute cholangitis…

A

fever
abd. pain
jaundice

40
Q

Reynolds pentad for acute cholangitis

A 
fever
abd. pain
jaundice
AMS
hypotension
41
Q

Tx for acute cholangitis

A

911 admit/surg consult

biliary drainage via ERCP

42
Q

which biliary d/o?

Women 30-65 yo

Autoimmune destruction of intrahepatic bile ducts → cholestasis

Can lead to liver failure/cirrhosis

A

primary biliary cholangitis

43
Q

Patient presents with…

Fatigue + Pruritus
Jaundice
RUQ discomfort
Xanthomas
Hepatomegaly
Hx of autoimmune conditions
A

PBC

44
Q

Labs for PBC

A

(+) AMA (hallmark)
cholestatic LFTs
(+) ANA
Hyperlipidemia

45
Q

To Dx PBC…

No extrahepatic biliary obstruction
\+
no liver comorbidities 
\+
2 of... (3)
A

elevated Alk Phos
(+) AMA
Histologic evidence

46
Q

Which biliary d/o?

MC in men

Assoc. w. UC

Leads to cholestasis, end-stage liver disease

A

PSC

47
Q

Male patient presents with…

Fatigue
Pruritus
Jaundice
Hepatomegaly

A

PSC

48
Q

Lab results for PSC

A

AMA NEG

cholestatic LFTs

49
Q

2 diagnostics helpful for PSC

A

cholangiography/MRCP/ERCP/PTC

Liver Bx

50
Q

3 complications of PSC…

A

End-stage liver disease
Hepatobiliary CA
Colon CA

51
Q

Which biliary d/o?

Inherited deficiency in biliary glucuronidation enzymes more common in men

Elevated UCB w/o hemolysis

A

Gilbert Syndrome

52
Q

Does Gilbert Syndrome require Tx?

A

no

53
Q

Male patient p/w:

mild intermittent jaundice triggered by dehydration, fasting

A

Gilbert Syndrome

54
Q

Which biliary neoplasm?

MC CA of biliary tract
Uncommon but fatal
Incidental finding

A

gallbladder CA

55
Q

RF for gallbladder CA?

A

procelain gallbladder

56
Q

Which biliary neoplasm?

Arise from epithelial bile duct cells

Rare, but more common in men

Associated with PSC and choledochal cysts

A

cholangiocarcinoma

57
Q

Patient p/w…

Jaundice
Pruritus
Abd. pain
Wt. loss
Fever
(+) Courvoisier sign
cholestatic LFTs
A

cholangiocarcinoma

58
Q

which biliary neoplasm?

Near ampulla of vater

Associated with FAP and HNPCC

A

ampullary carcinoma

59
Q

Patient p/w

Obstructive Jaundice

Occult GI bleed + microcytic anemia

Abd. pain

hx FAP or HNPCC

A

ampullary carcinoma

Clinical Medicine III (21 decks)

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