Hepatobiliary 2 - Paulson exam 3

Question 1

What is choledocolithiasis?

Answer 1

Stones in the common bile duct

Question 2

Symptoms of choledocolithiasis?

Answer 2

RUQ or epigastric pain, nausea, vomiting, possible jaundice.

Question 3

Lab abnormalities early in choledocolithiasis?

Answer 3

AST/ALT elevations

Question 4

Lab abnormalities late in choledocolithiasis?

Answer 4

Cholestatic pattern of elevation

Bilirubin, ALP, and GGT higher than ALT/AST

Question 5

First imaging study for suspected choledocolithiasis?

Answer 5

US

Question 6

Treatment for choledocolithiasis?

Answer 6

ERCP with stone removal

Question 7

What is acute cholangitis AKA ascending cholangitis?

Answer 7

Stasis and infection in the biliary tract

Question 8

Symptoms of acute cholangitis?

Answer 8

Fever, RUQ pain, jaundice, abd pain

Question 9

Common organisms isolated in acute cholangitis?

Answer 9

E. coli, Klebsiella, Enterobacter

Question 10

Triad of symptoms for acute cholangitis?

Answer 10

Charcot Triad: Fever, abd pain, jaundice

Question 11

Pentad of symptoms for acute cholangitis?

Answer 11

Reynolds Pentad: Confusion, hypotension, fever, abd pain, jaundice

Question 12

First places to be affected by jaundice?

Answer 12

Under tongue and eyes

Question 13

Lab abnormalities of acute cholangitis?

Answer 13

Leukocytosis with neutrophil predominance
Cholestatic pattern of LFTs: Increased ALP, GGT, and bilirubin
May have positive blood cultures

Question 14

Diagnostic criteria for acute cholangitis?

Answer 14

Tokyo Guidelines:
Acute cholangitis suspected if least one of: Fever, shaking chills, lab evidence of inflammatory response
PLUS
Jaundice or abnormal LFT’s
Diagnosis is definite if patient meets above criteria plus biliary dilatation on imaging or evidence of a etiology (stricture, stone, stent) on imaging

Question 15

Imaging study of choice for acute cholangitis in a patient with Charcot’s triad and abnormal LFTs?

Answer 15

ERCP

Question 16

Imaging study of choice for a patient suspected of acute cholangitis without Charcot’s triad?

Answer 16

US - if positive do ERCP

If normal do MRCP

Question 17

Treatment for acute cholangitis?

Answer 17

Admit, watch for sepsis, antibiotics and biliary drainage ASAP

Question 18

First line antibiotic choices for acute cholangitis?

Answer 18

Beta lactamase inhibitor
OR
3rd gen cephalosporin plus metronidazole

Question 19

T/F? Cholecystectomy is recommended in patients with acute cholangitis to prevent recurrence.

Answer 19

True

Question 20

What is Mirizzi syndrome?

Answer 20

Obstruction of the common hepatic duct due to extrinsic compression

Question 21

Symptoms of Mirizzi syndrome?

Answer 21

Jaundice, fever, RUQ pain

Question 22

Lab findings in Mirizzi syndrome?

Answer 22

Cholestatic pattern of LTFs

Elevated ALP and bilirubin

Question 23

Treatment for Mirizzi syndrome?

Answer 23

Cholecystectomy