Hepatobiliary 2- Paulson

Question 1

Stones within the common bile duct is called what?

Answer 1

Choledocholithiasis

D in choledoco for duct

Question 2

Patients with pain that is prolonged more so than typical biliary colic may have what disease?

Answer 2

Choledocholithiasis

Question 3

AST/ALT will be elevated early in what disease?

Answer 3

Choledocholithiasis

Question 4

How do you dx Choledocholithiasis if someone is at high risk for CBD stone?

Answer 4

U/S

Question 5

Tx for Choledocholithiasis

Answer 5

ERCP followed by cholecystectomy

Question 6

What is a really bad chole infection called? These pts are probably really sick

Answer 6

Acute Cholangitis aka Ascending Cholangitis

Question 7

So what even is Acute Cholangitis aka Ascending Cholangitis?

Answer 7

Biliary obstruction + bacterial infection

Question 8

Acute cholangitis involves charcot’s triad. What is it?

Answer 8

Charcot sounds like a charcut board (“Fancy Ass Jelly”)

• Fever
• Abd Pain
• Jaundice

Question 9

What is Reynolds pentad and what disease is it associated with?

Answer 9

Acute cholangitis and added on to charcots triad 
("fancy ass jelly with cured ham")
-Fever 
-Abd Pain 
-Jaundice 
-Confusion 
-Hypotension

Question 10

This disease shows a cholestatic pattern of LFTs. What does that mean and which disease? What other tests should they have that will be +?

Answer 10

Acute cholangitis

• ↑ALP, GGT, and bilirubin (mostly conjugated)

Blood cultures

Question 11

What imagining should be done in a patient with Charcots triad + abnormal LFTs?

Answer 11

ERCP - can confirm dx and get biliary drainage

Question 12

What imagining should be done in a patient with Charcots triad NOT present + abnormal LFTs?

Answer 12

Transabdominal U/S then if stone seen, need ECRP then if no stones seen need MCRP then ECRP

*ECRP is definitive ultimately

Question 13

Treatment for acute cholangitis?

Answer 13

Broad spectrum abx + ECRP

Question 14

This disease is a common hepatic duct obstruction from extrinsic compression (from an impacted stone in the cystic duct)

Answer 14

Mirizzi syndrome

Question 15

How to dx Mirizzi syndrome?

Answer 15

U/S then ECRP

Question 16

How to tx Mirizzi syndrome?

Answer 16

Surgey (cholecystectomy)

Question 17

This disease is due to chronic inflammation and resultant scarring of the liver?

Answer 17

Cirrhosis

Question 18

What are common skin findings in cirrhosis?

Answer 18

Jaundice, spider angioma, palmar erythema

Question 19

Abnormal finding in males with cirrhosis?

Answer 19

gynecomastia

Question 20

Abdominal findings in cirrhosis?

Answer 20

ascites, palpable liver, splenomegaly, caput medusa

Question 21

What is a cruveilhier-baumgarten murmur

Answer 21

Venous hum that may be auscultated in patients with portal HTN, best heard over epigastrium

Question 22

What toxin is responsible for neuro probs in cirrhosis?

Answer 22

Ammonia

Question 23

What are Muehrcke nails?

Answer 23

Paired white horizontal bands separated by normal color

Question 24

What are Terry nails?

Answer 24

Proximal 2/3 of the nail plate appears white, distal 1/3 is red

Question 25

This lab level is really high in those with cirrhosis?

Answer 25

GGT Gonna Get Tipsy

Question 26

As cirrhosis progresses, bilirubin _______ and albumin _______

Answer 26

bilirubin increase and albumin decrease

Question 27

T/F: hyponatremia is common in cirrhosis patients

Answer 27

True

Question 28

What is the gold standard to diagnose cirrhosis?

Answer 28

Liver biopsy

Question 29

What is a good imaging way to make cirrhosis dx?

Answer 29

U/S

Question 30

If a patient with cirrhosis has variceal hemorrhages, what is the best treatment?

Answer 30

Beta blockers (propanolol) Also variceal band ligation common

Question 31

How do you treat asictes in cirrhosis?

Answer 31

Diuretics and sodium restiction

Question 32

Mainstay ascites tx?

Answer 32

Spironolactone + Furosemide in 100:40 mg ratio

Question 33

If a patient has spontaneous bacterial perotinitis, how do you dx this?

Answer 33

First of all this is when your ascites become infected with bacteria -paracentesis

Question 34

What is the tx for spontaneous bacterial perotinitis?

Answer 34

3rd gen cephalosporin (cefotaxime)

Question 35

Those who have survived an episode of spontaneous bacterial perotinitis should be treated with what?

Answer 35

Bactrim

Question 36

How to treat a hepatic hydrothorax?

Answer 36

Usually right sided pleural effusion Diuretics + sodium restriction

Question 37

In cirrhosis patients with dyspnea, platypnea, imparied oxygen, what should we think of and how do we treat it?

Answer 37

Hepatopulmonary syndrome and with liver transplant and O2 therapy

Question 38

How do you treat hepatic encephalopathy?

Answer 38

Lactulose

Question 39

If people can't tolerate lactulose, what should be given?

Answer 39

Rifaximin

Question 40

How to dx portopulmonary htn (pulm htn in pt with portal htn)?

Answer 40

Echo and confirm with R heart cath

Question 41

What is a child-pugh score?

Answer 41

Used to predict survival of cirrhosis patients

Question 42

What is a MELD score? and at what point do you refer patients?

Answer 42

Used to prioritize patients awaiting liver transplant (greater than or equal to 10) and usually a candidate at greater than or equal to 15