Hepatobiliary Diseases

Question 1

Cholelithiasis patho and management

Answer 1

Asymptomatic gallstones should be monitored and observed.

Question 2

Biliary Colic Treatment

Answer 2

elective cholecystectomy.

Question 3

Acute Ascending Cholangitis patho

Answer 3

life-threatening emergency caused by obstruction of the common bile duct (CBD) with a gallstone that has escaped the gallbladder

Question 4

Acute Ascending Cholangitis cxfx

Answer 4

Jaundice
Fever
RUQ pain
[Charcot triad]
Altered mental status
Hypotension or shock
{add these two to ChrcTrd and you have Reynolds Pentad]

Question 5

Acute Ascending Cholangitis best initial test is

Answer 5

an abdominal ultrasound aken once the patient is stable.

dilated intra- and extrahepatic ducts along with a dilated CBD indicate obstruction.

Question 6

Acute Ascending Cholangitis The most accurate test

Answer 6

MRCP of the abdomen.

Question 7

Acute Ascending Cholangitis Tx

Answer 7

IV antibiotics followed by ERCP to decompress the CBD and remove the stone.

Question 8

Acute Ascending Cholangitis If the patient is unstable, the best
next step is

Answer 8

decompression of the CBD through the liver by percutaneous transhepatic cholangiogram (PTC).
Eventually the patient must undergo an elective cholecystectomy

Question 9

a patient who presents after cholecystectomy with fever, abdominal pain, and/or bilious ascites: think about

Answer 9

Biliary leakage

Question 10

The most accurate test for bile leak is

Answer 10

HIDA scan

Question 11

Large loculated collections (of Biliary leakage) should be [tx]

Answer 11

percutaneously drained with radiologic guidance.

Question 12

a tumour occurring at the confluence of the right and left hepatic bile ducts. is a:

Answer 12

A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma

Question 13

Sphincter of Oddi dysfunction (SOD) patho

Answer 13

clinical syndrome of biliary or pancreatic obstruction related to mechanical or functional abnormalities of the sphincter

Question 14

SOD cx fx

Episodes lasting_

Answer 14

30 minutes or longer

Question 15

SOD cx fx

Recurrent symptoms occurring at ____ intervals ____

Answer 15

different

not daily

Question 16

SOD cx fx

Pain that builds up to a _____

Answer 16

steady level

Question 17

SOD cx fx

Pain severe enough to interrupt the patient’s ____ or lead to an _____

Answer 17

daily activities

emergency department visit

Question 18

SOD cx fx

Pain not significantly related to____

Answer 18

bowel movements

Question 19

SOD cx fx

Pain not significantly relieved by

Answer 19

postural change or acid suppression

Question 20

______ is the most accurate test for diagnosing of

SOD.

Answer 20

Sphincter of Oddi manometry (SOM)

Question 21

The goal of treating patients with symptomatic SOD is to __________ by improving the ______

Answer 21

eliminate pain and/or recurrent pancreatitis.

flow of biliary and pancreatic secretions

Question 22

SOD type I features

Answer 22

Biliary-type pain, abnormal

liver tests,

Question 23

SOD both type I and II feature

Answer 23

dilated common bile duct

Question 24

SOD type II features

Answer 24

Biliary-type pain plus abnormal liver tests OR dilated common bile duct

Question 25

SOD type III features

Answer 25

Biliary-type pain, normal liver tests,

Question 26

SOD type I management

Answer 26

Endoscopic sphincterotomy without preprocedure SOM (offers greatest relief for the patient)

Question 27

SOD type II management

Answer 27

SOM (manometry) followed by endoscopic sphincterotomy (most common cause: sphincter of Oddi stenosis)

Question 28

SOD type III management

Answer 28

Medical management without endoscopic sphincterotomy