Hepatobiliary Disease Lecture Powerpoint

Question 1

Pancreatic malignancy usually begins where?

Answer 1

The head of the pancreas - narrows the common bile duct causing painless jaundice

Question 2

Bile is made ____, and the gallbladder functions to ____ it for storage

Answer 2

constantly, store it

Question 3

Bile acid metabolic function

Answer 3

Coats products of lipid breakdown to form micelles to help with fat absorption thru this intestinal epithelium

Question 4

Conjugated bilirubin is not reabsorbed. It enters the colon and is converted to….

Answer 4

….urobilinogen by bacteria, from there some is reabsorbed and secreted into urine (yellow color), most exit colon via conversion to urobilin and sterobilin (brown color)

Question 5

Congenital abnormalities of the gallbladder

Answer 5

• gallbladder agenesis
• cholecystohepatic duct (gallbladder connects to an intrahepatic duct resulting in potential bile leak if cholecystectomy if not identified and clipped)

Question 6

Cholelithiasis

Answer 6

Common condition increasing prevalence with age composed of 4 stages

• lithogenic stage (conditions favorable for stone formation)
• asymptomatic gallstone (stones formed, may rest for years)
• symptomatic gallstones (biliary colic)
• complicated cholelithiasis

Question 7

Most common type of cholelithiasis

Answer 7

Cholesterol stones

Question 8

Risk factors for cholesterol stones (4)

Answer 8

• female
• age
• obesity
• estrogens

Question 9

Clinical presentation of cholelithiasis

Answer 9

Often asymptomatic for decades and don’t require treatment, eventually begin to demonstrate biliary colic (patternless epigastric pain usually 30-90 min right upper quadrant random times) alongside n/v, diaphoresis, but no fever, jaundice, or peritoneal signs

Question 10

Studies for cholelithiasis (5)

Answer 10

• CBC
• LFT
• amylase and lipase
• ultrasound (will pick up solid stones, test of choice***)
• CT if stone is in common bile duct

Question 11

Porcelain gallbladder

Answer 11

Findings of calcification of the gall bladder wall that is cancer until proven otherwise

Question 12

Cholelithiasis treatment options (2)

Answer 12

• cholecystectomy upon emergent symptoms, sometimes prophylactically in large stones, first line
• extracorporal shockwave lithotripsy

Question 13

Acute cholecystitis

Answer 13

Complication of cholelithiasis in long term, inflammation of the GB, in 20% of pts with biliary colic, have colicky pain that becomes constant and may radiate as well as associated N/V and FEVER*** as well as positive murphy’s sign

Question 14

Risk factors for cholecystitis

Answer 14

• rapid weight loss
• increasing age
• medications (including hormone therapy)

Question 15

Acute cholecystitis diagnostic studies (4)

Answer 15

• CBC
• pregnancy test to rule out
• ultrasound (very sensitive and specific)
• CT as backup

Question 16

Acute cholecystitis treatment (4)

Answer 16

• bowel rest
• ampicillin or 3rd gen cephalosporin
• laproscopic cholecystectomy
• percutaneous drainage (if can’t do surgery)

Question 17

Acalculous cholecystitis and how is it diagnosed (1)

Answer 17

Condition occurring in severely ill patients presenting very similar to acute cholecystitis but is not visible on ultrasound, diagnosed via HIDA/CCK scan

Question 18

Chronic cholecystitis and how is it treated? (1)

Answer 18

Repeated attacks of biliary colic where the gallbladder is damaged by repeated attacks of acute inflammation, requires cholelecystectomy as treatment

Question 19

Choledocholithias

Answer 19

Stone within the common bile duct originating from the gall bladder resulting in a colicky pattern and posing risk for cholangitis with obstruction

Question 20

Acute cholangitis and treatment options (2)q

Answer 20

Bile duct obstruction (stone, scarring, tumor) causing bacteria from duodenum to ascend into the common bile duct resulting in the charcot triad of presentation (abodminal pain, jaundice, fever) requiring antibiotics and relief of obstruction for treatment

Question 21

Charcot triad and Reynold’s pentad

Answer 21

Seen in presentation of acute cholangitis involving abdominal pain, jaundice, and feve for charcot triad and additional confusion and hypotension in reynold’s pentad

Question 22

Primary sclerosing cholangitis has strong association with…

Answer 22

…ulcerative colitis

Question 23

Primary sclerosing cholangitis

Answer 23

Chronic liver disease with progressive cholestasis and inflammation and fibrosis of intrahepatic and extrahepatic ducts, thought to be autoimmune

Question 24

Primary sclerosing cholangitis lab findings (2) and treatment (2)

Answer 24

• LFT cholestatic pattern
• MRCP beaded appearance
• steroids
• liver transplant