HEPATOBILIARY 2 Flashcards
Jaundice, weight loss, epigastric pain
Pancreatic cancer
2 major risk factors for pancreatic cacner
Smoking
Chronic Pancreatitis
Unique findings in carcinoma of the HEAD of the pancreas
Conjugated hyperbilirubemia / Jaundice
Pale Stools
Dark urine (due to CB)
Itching
Serum marker for pancreatic cancer
CA 19-9
biliary atresia embryo defect
Failure to form the extrahepatic biliary tree
biliary atresia presentaion
conjugated hyperbilirubinemia
Jaundice and cirrhosis in an INFANT
3 risk factors for CHOLESTEROL stone formation
Supersaturation of bile
DECREASED bile acid, decreased phosphatidylcholine
Stasis, high estrogen, low cck, high progesterone
Cholesterol stone, gross and Xray
Radiolucent…may possibly be radiopaque
Yellow/faceted
Bilirubin stones, gross and Xray
Radiolucent
Black
causes of brown stones
Biliary Tree infection
the causative organism of acute cholangitis
E.coli
RUQ pain radiating to the shoulder, Nausea and Vomiting
Acute Cholecystitis
Acute Cholecystitis labs (alk phos)
Increased Alk Phos + increased y-glutamyltransferase
(osteoblasts also release alk phos)…non specific
Acalculous Cholecystitis causes
Critically ill patients (burns, sepsis) to develop cholecystitis w/o stones
Makes sense b/c critically ill pts often have SHOCK = decreased blood flow = inflammation = infection to gall bladder
Which type of calcification causes porcelan gallbladder
Dystrophic
Most common pathogens causing ascending cholangitis
gram negative enterics
Parasites that target the liver
Triad of symptoms for ascending cholangitis
Sepsis
Jaundice
Abdominal pain
Biggest risk factor for ascending cholangitis
Choledocolithiasis
RLQ pain, Xray reveals air in the biliary tree
Gallstone illeus
Gallbladder carcinoma arises from
glandular epithleium –> Adenocarcinoma
Classic patient with gallbladder cancer is
Elderly female with cholecystitis
Unconjugated hyperbilirubinemia labs (hemolysis)
Increased UB
Increased urine Urobilinogen (more shunted during enterohepatic cycling)
No urine CB
Conjugated hyperbilirubinemia labs
Increased CB
no Urine urobilinogen (no CB made it to the gut to be converted)
Increased Urine CB and bile salts (CB refluxes backward into sinusoids)
Mixed hyperbilirubinemia is a result of
Hepatitis (viral or alcoholi)
Physiologic jaundice of newborn defect
low UDPgluconyltransferase levels –> high UCB
Physiologic jaundice of newborn tx and mechanism
Phototherapy –> converts UCB to CB
Gilbert syndrome
mildly low UDPgluconyltransferase levels
Crigler Najjar 1 syndrome
ABSENT UDPgluconyltransferase levels –> high UCB
Crigler najjar presentation
neonatal kernicterus
Gilbet inheritance
AR