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CPD II > GI test 2: Gallbladder disorders > Flashcards

GI test 2: Gallbladder disorders Flashcards

1
Q

What is cholelithiasis? Most stones result from what?

A

presence of one or more calculi, most d/o’s of teh biliary tract result from gallstones

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2
Q

Prevalence and RF’s of cholelithiasis?

A

prevalence: developed countries: 10% of adults & 20% ppl >65 yo have gallstones
RFs: 5 F’s: female, fat, fertile, forty, family hx; female, obesity, western diet, american indian ethnicity

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3
Q

Pathophys of cholelithiasis. Types of stones?

A

biliary sludge= precursor to gallstones develop during GB stasis

  1. cholesterol stones: >85% in western world, bile supersaturated w/chol usu from excessive chol secretion (diabetes, obesity)
  2. black pigment stones: small & hard, Ca2+ bilirubinate & inorganic salt
  3. brown pigment stones: soft & greasy, bilirubinate & FA’s, form during infxn, inflam & parasitic infxns
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4
Q

Ssxs of cholelithiasis?

A

80% asx, biliary colic, RUQ pain that may radiate into back or down R arm, pain beings suddenly, intense in 15 mins-1 hr, steady for up to 12 hrs, gradually disappears leaving dull ache, N/V common w/attacks, fever UNCOMMON

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5
Q

W/u cholelithiasis

A

labs usu unrevealing

abd US diagnostic

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6
Q

What is cholecystitis?

A

inflam of GB, acute or chronic

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7
Q

What is acute cholecystitis? cause? prevalence? complication of what?

A

inflam of GB, develops over hrs usu dt gallstone obstructing cystic duct
most common complication of cholelithiasis, >95% who have also have cholelithiasis

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8
Q

Ssxs of cholecystitis?

A

pain similar in quality & location to biliary colic but lasts >6 hrs
begins to subside in 2-3 d, resolves in 1 wk in most, vomiting common

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9
Q

PE of cholecystitis?

A

R subcostal tenderness, + Murphy’s, FEVER

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10
Q

W/u for cholecystitis?

A

abd US, cholescintigraphy if US equivocal, abd CT can help identify complications (GB performation–> peritonitis, pancreatitis)

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11
Q

What is chronic cholecystitis? range of damage?

A

longstanding GB inflam, almost always dt stones
damage ranges from modest infiltrate to fibrotic, shrunken GB
extensive calcification= PORCELAIN GB

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12
Q

Ssxs of chronic cholecystitis

A

recurrent biliary colic

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13
Q

PE of chronic cholecysitis

A

upper abdominal tenderness, afebrile

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14
Q

W/u for chronic cholecystitis

A

abd US, gallstones & mb shrunken, fibrotic GB

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15
Q

What is acalculous biliary pain? when would you suspect?

A

biliary colic w/o gallstones, dt structural or functional d/o’s, suspected in pts w/biliary colic & DI can’t detect gallstones

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16
Q

Causes of acalulous biliary pain?

A 
microscopic stones
abn GB emptying
overly sensitive biliary tract
sphincter of Odi dysfxn
hypersensitivity of adjacent duodenum
possibly gallstones that have passed
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17
Q

W/u of acalculous biliary pain

A

labs may reveal abn biliary tract (elevated alk phos, bilirubin, AST, ALT) or pancreatic abn (elevated lipase)
abd US, endoscopic ultrasonography, ERCP w/biliary manometry may reveal sphincter of Odi dysfxn

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18
Q

What is postcholecystectomy syndrome?

A

occurrence of abd sxs after cholecystectomy

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19
Q

Causes of postcholecystectomy syndrome? Consequences?

A

alterations in bile flow dt loss of reservoir fxn of GB

consequences: increased bile flow into upper GI (esophagitis & gastritis) or lower GI (diarrhea, colicky lower abd pain)

20
Q

Other contributing factors of postcholecystectomy syndrome?

A

papillary stenosis (rare), retained bile duct stone, pancreatitis, GERD

21
Q

Prevalence of postcholecystectomy syndrome?

A

5-40% of post-op pts

22
Q

Ssxs of postcholecystectomy syndrome?

A

dyspepsia, non-specific biliary sxs rather than true biliary colic, persistent abd pain

23
Q

W/u of postcholecystectomy syndrome?

A

biliary manometry during ERCP (ERCP has increased risk of inducing pancreatitis): shows increased P in biliary tract w/pain, slowed hepatic hilum-duodenal transit time suggests sphincter of Odi dysfxn

24
Q

What is choledocholithiasis?

A

presence of stones in bile ducts causing biliary colic, obstruction & gallstone pancreatitis or cholangitis

25
Q

Types of choledocholithiasis

A

primary stones: usu brown stones, form in bile duct
secondary stones: usu chol, form in GB & migrate to bile ducts, developed countries >85% are these
residual stones: missed at time of cholecystectomy (>3 yrs later)
recurrent stones: recur >3 yrs post-op

26
Q

Ssxs of choledocholithiasis

A

stones may pass into duodenum= asx, biliary colic when duct partially obstructed

27
Q

course of choledocholelithiasis

A

more complete obstruction causes: dust dilation, jaundice, eventually cholangitis (bac infxn), stones that obstruct Ampulla of Vater can cause gallstone pancreatitis

28
Q

What is cholangitis? 3 types?

A

bile duct infxn & inflm, can lead to strictures, stasis & choledocholithiasis
acute cholangitis= EMERGENCY
recurrent pyogenic cholangitis
sclerosing cholangitis

29
Q

What is acute cholangitis? Common causes?

A

AN EMERGENCY!!!
bile duct obstruction & subsequent bac ascend from duodenum
most from common bile duct stones but bild duct obstruction can also occur from tumors & other conditions
common bugs: gram-neg bac, less commonly gram pos & mixed anaerobes

30
Q

Ssxs of acute cholangitis?

A

CHARCOT’S TRIAD: abd pain, jaundice, fever or chills

31
Q

PE for acute cholangitis?

Morbidity rate?

A

RUQ abd tenderness, hepatomegaly and tenderness, often containing abscesses, confusion & hypoTN predict ~50% of mortality rate
HIGH MORBIDITY

32
Q

What is recurrent pyogenic cholangitis?

A

intrahepatic brown stones lead to cycles of obstruction, infxn & inflam

33
Q

What type of stones form in recurrent pyogenic cholangitis? Where are they? Prevalence? Causes/RFs?

A

brown stones: sludge & bac debris in the bile ducts

prevalence: occurs in SE asia
causes: undernutrition & parasitic infxn increases susceptibility

34
Q

When should you suspect a common duct stone? When would you suspect acute cholangitis?

A

common duct stone: in pt w/jaundice, biliary colic

acute cholangitis: jaundice, biliary colic and FEVER and leukocytosis present

35
Q

W/u for choledocholithiasis and cholangitis? (labs & procedure)

A

labs: suggesting stone/extrahepatic obstruction= elev bilirubin, alk phos, ALT, GGT
suggesting acute cholangitis: leukocytosis, AST & ALT elevated suggest hepatic necrosis dt microabscesses
procedure: abd US

36
Q

What is sclerosing cholangitis? 2 subclasses? Causes in each subclass?

A 
chronic choleastatic syndromes w/patchy inflam, fibrosis & strictures of intrahepatic & extrahepatic bile ducts
mb primary (no known cause) or secondary (immune deficiencies, congenital in children, acquired in adults (AIDS)) which leads to inflam & fibrosis of bile ducts
37
Q

What is primary sclerosing cholangitis? prevalence? RF’s?

A

most common form
no known cause
80% have IBD, usu ulcerative colitis

38
Q

Ssxs of sclerosing cholangitis?

A

progressive fatigue then pruritis, jaundice later, steatorrhea & deficiencies of fat sol vits, syptomatic gallstones & choledocholithitasis develop in ~75%, some asx until late in course & present w/hepatosplenomegaly or cirrhosis

39
Q

W/u (labs & imaging) for sclerosing cholangitis?

A

labs: elev alk phos, GGT, gamma globulin & IgM; antimito ab negative
imaging: 1st US to exclude extrahepatic biliary obstruction, MRCP: multiple strictures in intrahepatic & extrahepatic bile ducts
ERCP: 2nd choice b/c invasive
liver bx not needed for dx but will show bile duct proliferation, periductal fibrosis, inflam & loss of bile ducts

40
Q

Complications of sclerosing cholangitis?

A

cholangiocarcinoma develops in 10-15% of pts

41
Q

what is AIDS cholangiopathy?

A

biliary obstruction secondary to biliary tract strictures dt various opportunistic infxns
before antiretroviral tx, cholangiopathy occurred in about 25% of AIDS pts, esp those w/low CD4 counts

42
Q

Ssxs of AIDS cholangiopathy?

A

RUQ & epigastric pain, severe pain= papillary stones, milder pain- sclerosing cholangitis; diarrhea, few have fever & jaundice

43
Q

W/u of AIDS cholangiopathy?

A

labs: elev alk phos, GGT
imaging: ERCP & US

44
Q

What are the types of tumors of the GB & bile ducts? What can they cause?

A

Can cause extrahepatic biliary obstruction
cholangiocarcinoma
GB carcinoma
GB polyps

45
Q

Prevalence of cholangiocarcinoma? Most likely to occur? RF’s? Ssxs? PE?

A

rare occurrence but usu malignant, usu in extrahepatic bile duct
RF’s: primary sclerosing cholangitis, older, infestation w/liver flukes, choledochal cyst
Ssxs: pruritis, painless obstructive jaundice, abd pain, anorexia & wt loss
PE: non-tender palpable mass (courvoisier’s sign), hepatomegaly

46
Q

GB carcinoma prevalence, RF’s, Ssxs, prognosis

A

uncommon
RF’s: native american, large gall stones, GB calcification dt chronic cholecystitis (porcelain GB), nearly all have gallstones (70-90%)
Ssxs: varies w/course of dz, asx–> biliary pn–> advanced dz: wt loss, constant pn, abd mass, obstructive jaundice
prognosis: median survival 3 mo., cure possible if found early

47
Q

What are GB polyps?

A

usu asx benign mucosal projections in lumen of GB, most sm., usu found on US, require no tx

CPD II (10 decks)

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