GI- Billiary

Question 1

Cholangiocarcinoma

Answer 1

lethal malignancy of the bile duct epithelium. ↑ risk in fibropolycystic liver disease or primary sclerosis cholangitis.

Question 2

S&S cholangiocarcinoma

Answer 2

Abdominal pain
Weight Loss
Hyperbilirubinemia 
Cholestatic Liver enzyme pattern (↑ alk phos, normal/mild AST, ALT)
Hepatomegaly/ palpable RUQ mass

Question 3

Diagnosis of cholangiocarcinoma

Answer 3

↑CEA
↑CA19-9
Normal AFP
Imaging: intrahepatic or common bile duct dilation, biliary mass.

ERCP tissue biopsy: confirm diagnosis

Question 4

Ddx hepatocellular carcinoma and cholangiocarcinoma

Answer 4

HCC: normal CEA and CA19-9, Elevated AFP (50% time)

Cholangiocarcinoma: ^ CAE, CA19-9

Question 5

Ddx Pancreatic cancer and cholangio carcinoma

Answer 5

both elevated CA19-9

pancreatic: distal biliary obstruction.

Question 6

Emphysematous cholecystitis

Answer 6

Occurs when gas-forming organism (clostridium, e.coli) infect damaged or ischemic tissue in the gallbladder wall. Bacterial exotoxins result in hemolysis, tissue necrosis and septic shock.

Question 7

Management of emphysematous cholecystitis

Answer 7

EC can progress to gangrenous chole or perforation in most pts and requires emergent cholecystectomy and broad-spec abx.

Question 8

S&S emphysematous cholecystitis

Answer 8

Fever, N/V
RUQ pain/ guarding/ crepitus 
Pneumobilia 
Unconjugated hyperbilirubunemia 
Leukocytosis 
Mild elevated aminotransferases

Question 9

Diagnosis emphysematous cholecystitis

Answer 9

CT imaging is preferred. U/S is less sensitive due to poor visualization of air-filled structures.