Hepatobiliary Disease Lecture Powerpoint Flashcards
Pancreatic malignancy usually begins where?
The head of the pancreas - narrows the common bile duct causing painless jaundice
Bile is made ____, and the gallbladder functions to ____ it for storage
constantly, store it
Bile acid metabolic function
Coats products of lipid breakdown to form micelles to help with fat absorption thru this intestinal epithelium
Conjugated bilirubin is not reabsorbed. It enters the colon and is converted to….
….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)
Congenital abnormalities of the gallbladder
- gallbladder agenesis
- cholecystohepatic duct (gallbladder connects to an intrahepatic duct resulting in potential bile leak if cholecystectomy if not identified and clipped)
Cholelithiasis
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
Most common type of cholelithiasis
Cholesterol stones
Risk factors for cholesterol stones (4)
- female
- age
- obesity
- estrogens
Clinical presentation of cholelithiasis
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
Studies for cholelithiasis (5)
- CBC
- LFT
- amylase and lipase
- ultrasound (will pick up solid stones, test of choice***)
- CT if stone is in common bile duct
Porcelain gallbladder
Findings of calcification of the gall bladder wall that is cancer until proven otherwise
Cholelithiasis treatment options (2)
- cholecystectomy upon emergent symptoms, sometimes prophylactically in large stones, first line
- extracorporal shockwave lithotripsy
Acute cholecystitis
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
Risk factors for cholecystitis
- rapid weight loss
- increasing age
- medications (including hormone therapy)
Acute cholecystitis diagnostic studies (4)
- CBC
- pregnancy test to rule out
- ultrasound (very sensitive and specific)
- CT as backup
Acute cholecystitis treatment (4)
- bowel rest
- ampicillin or 3rd gen cephalosporin
- laproscopic cholecystectomy
- percutaneous drainage (if can’t do surgery)
Acalculous cholecystitis and how is it diagnosed (1)
Condition occurring in severely ill patients presenting very similar to acute cholecystitis but is not visible on ultrasound, diagnosed via HIDA/CCK scan
Chronic cholecystitis and how is it treated? (1)
Repeated attacks of biliary colic where the gallbladder is damaged by repeated attacks of acute inflammation, requires cholelecystectomy as treatment
Choledocholithias
Stone within the common bile duct originating from the gall bladder resulting in a colicky pattern and posing risk for cholangitis with obstruction
Acute cholangitis and treatment options (2)q
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
Charcot triad and Reynold’s pentad
Seen in presentation of acute cholangitis involving abdominal pain, jaundice, and feve for charcot triad and additional confusion and hypotension in reynold’s pentad
Primary sclerosing cholangitis has strong association with…
…ulcerative colitis
Primary sclerosing cholangitis
Chronic liver disease with progressive cholestasis and inflammation and fibrosis of intrahepatic and extrahepatic ducts, thought to be autoimmune
Primary sclerosing cholangitis lab findings (2) and treatment (2)
- LFT cholestatic pattern
- MRCP beaded appearance
- steroids
- liver transplant