Hepatobiliary 1 - Paulson Exam 3 Flashcards

1
Q

Functions of the liver include:

A
Gluconeogenesis and glycogenesis
Detoxification
Produces bile
Producing clotting factors II, VII, IX, X
Produces proteins
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2
Q

Function of bile?

A

Helps absorb fat

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3
Q

Unconjugated Bilirubin is a product of RBC breakdown. How is it used?

A

Liver conjugates bilirubin, which is then a component of bile

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4
Q

What is the cause of jaundice?

A

Increase in either unconjugated or conjugated bilirubin

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5
Q

What other symptoms are related to bilirubin?

A

Clay colored stools
Dark tea colored urine
Pruritis

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6
Q

What are some causes of increased unconjugated bilirubin?

A

Increased production of bilirubin (hemolytic anemia)
Decreased uptake of bilirubin by the liver
Decreased conjugation of bilirubin by the liver

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7
Q

What genetic syndromes can cause increased unconjugated bilirubin?

A

Gilbert syndrome

Crigler-Najjar syndrome

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8
Q

What are some causes of increased conjugated bilirubin?

A

Liver does not secrete bilirubin into bile ducts

Biliary tree obstruction

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9
Q

What is cholelithiasis?

A

Gallstones

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10
Q

What can gallstones be made of?

A

Cholesterol or pigment stones

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11
Q

What type of gallstones are more common?

A

Cholesterol (90%)

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12
Q

What are the different types of pigment stones?

What do they indicate?

A

Black stones - formed in sterile bile

Brown stones - from bacterial metabolism in biliary infection.

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13
Q

5 F’s of cholesterol stones

A
Fat
Forty
Female
Fertile
Fair skined
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14
Q

_______ predisposes women to gal stones due to increased levels of estrogen

A

Pregnancy

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15
Q

What percentage of cholelithiasis’ will be asymptomatic?

A

80%

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16
Q

What causes symptoms in cholelithiasis?

A

Intermitent blockage of cystic duct by a stone - this is called a biliary colic

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17
Q

Describe the pain associated with a biliary colic?

A

Intense, dull discomfort in RUQ that may radiate to the back (R shoulder blade)

18
Q

What other symptoms can be caused by cholelithiasis?

A

Nausea, vomiting, diaphoresis

19
Q

What can trigger symptoms from cholelithiasis?

A

Eating a large fatty meal

20
Q

What is the imaging study of choice for cholelithiasis?

21
Q

What US findings indicate a stone?

A

An acoustic shadow or sludge

22
Q

What lab abnormalities are present during biliary colic?

A

No abnormalities

23
Q

T/F? Emergent cholecystectomy is indicated in patients with biliary colic

A

False. Can be scheduled on non emergent basis

24
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder

25
What are the two categories of acute cholecystitis? Describe the typical patient for each.
Calculous - women between 40 and 60 | Acalculous -critically ill, bedridden elderly patients, patients on TPN, more common in men
26
Pathophysiology of calculous cholecystitis?
Cystic duct becomes obstructed by stone, leading to inflammation. Bacterial inflammation present in 50-85% of patients.
27
Most common organisms of acute bacterial cholecystitis?
E. coli, Klebsiella species, Streptococcus species, and Clostridium species.
28
Pathophysiology for acalculous cholecystisis?
>50% have no underlying explanation | Some may have biliary sludge in cystic duct, or other weird causes for obstruction of gallbladder
29
Classic presentation of acute cholecystitis?
RUQ pain radiating to right shoulder/back. Nausea/vomiting Ate a fatty meal before presentation. Pain lasting 4-6 hours
30
Physical exam findings for acute cholecystisis?
``` Tachycardia Fever Guarding Rebound tenderness Positive murphy's sign ```
31
Lab abnormalities in acute cholecystitis?
Leukocytosis with left shift | Mild elevation of LFTs
32
Imaging study of choice for acute cholecystitis?
US | HIDA scan if still uncertain after US
33
What US findings are indicative of acute cholecystitis?
Gallbladder wall thickening or edema Sonographic murphy's sign Pericholecystic fluid and dilation of the bile duct
34
How does a HIDA scan work?
Technetium labeled HIDA injected IV Taken up by hepatocytes and excreted into bile If cystic duct is patent, tracer enters gallbladder which can be visualized.
35
T/F? Gallbladder visualization after HIDA administration is a positive test
False
36
Most common complication of untreated cholecystitis?
Gangrenous cholecystitis
37
Treatment for acute cholecystitis?
Pain control - NSAIDs or opioids Antibiotics Cholecystectomy or cholecystotomy
38
First line antibiotics for cholecystitis?
Cefazolin, cefuroxime, or ceftriaxone
39
Cholecystectomy vs cholecystotomy
Cholecystectomy is removal of the gallbladder. Can be done laparoscopic Cholecystotomy is percutaneous drainage of the gallbladder done by IR
40
What is a porcelain gallbladder?
Calcification of the gallbladder wall associated with cholelithiasis. Usually diagnosed incidentally.
41
Porcelain gallbladder increases risk for ______
Gallbladder carcinoma
42
Treatment for porcelain gallbladder?
Surgical resection