High-Yield Concepts in Gallbladder and Biliary Diseases (Gastrointestinal Diseases) Flashcards
2 major type of Gallstones
Cholesterol stones (>80%) Pigment stones (
Most important mechanism in the formation of lithogenic bile
Increased biliary secretion of cholesterol
2 key changes during pregnancy that contribute to a cholelithogenic state
∙ A marked increase in cholesterol saturation of bile during the 3rd trimester
∙ Sluggish gallbladder contraction in response to a standard meal → impaired gallbladder emptying
Most frequently isolated organisms in gallbladder bile
Escherichia coli, Klebsiella spp., Streptococcus spp., Clostridium spp.
Most frequently cultured bacteria in Emphysematous Cholecystitis
Anaerobes, such as Clostridium welchii or Clostridium perfringens
Aerobes, such as E.coli
Mostfrequent demographic for Emphysematous Cholecystitis
Elderly men and diabetics
Radiographic diagnosis of Emphysematous Cholecystitis
Gas within the gallbladder lumen on plain abdominal film, dissecting within the gallbladder wall to form a gaseous ring
Murphy’s Sign
Deep inspiration or cough during subcostal palpation of the RUQ produces increased pain and inspiratory arrst, suggestive of acute cholecystitis or cholangitis
Mirizzi’s Syndrome
Gallstones becomes impacted in the cystic duct or neck of the gallbladder causing compression of the CBD, resulting in obstruction and jaundice
Courvoisier’s Law
Presence of a palpably enlarged gallbladder suggests that the biliary obstruction is secondary to an underlying malignancy rather than to calculous disease
Sonographic criteria for identifying gallstones
Acoustic “shadowing” of opacities that are within the gallbladder lumen
Change with the patient’s position (by gravity)
Most common site of fistula formation in Cholecystitis
Fistula in the duodenum
Usual site of obstruction in gallstone Ileus
Ileocecal Valve
Porcelain Gallbladder
Calcium salt deposition within the wall of a chronically inflamed gallbladder; associated with gallbladder carcinoma, so cholecystectomy is advised
Usual analgesics for Acute Cholecystitis
Meperidine or NSAIDs (produce less spasm of sphincter of Oddi than morphine)
Gold standard for treating symptomatic Cholelithiasis
Laparoscopic cholecystectomy
Treatment of choice for Acute Cholecystitis
Early cholecystectomy (within 72 hours)
Delayed surgical intervention in Cholecystitis
Overall medical condition imposes an unacceptable risk for early surgery
Diagnosis of acute cholecystitis in doubt
Most common cause of persistent Postcholecystectomy Symptoms
Overlooked symptomatic nonbiliary disorder (reflux esophagitis, peptic ulceration, pancreatitis, or most often, irritable bowel syndrome)
Most common biliary anomalies in infancy
Biliary atresia and hypoplasia
Caroli’s Disease
Congenital biliary ectasia involving the major intrahepatic radicles
Most common type of Cholangitis
Nonsuppurative acute cholangitis (vs. suppurative)
Procedure of choice for Cholangitis
ERCP with endoscopic sphincterotomy (both diagnostic and therapeutic)
Most common associated entity in patients with Nonalcoholic Acute Pancreatitis
Biliary tract disease
Risk factors for concomitant CBD stones in patients iwth Gallstones
History of jaundice or pancreatitis
Abnormal tests of liver function
Ultrasonographic or MRCP evidence of a dilated CBD
Preferred approach if CBD stones are suspected prior to Laparoscopic Cholecystectomy
Preoperative ERCP with endoscopic papillotomy and stone extraction
Treatment of choice for Choledocholithiasis
Endoscopic biliary sphincterotomy (EBS)
Most common cause of benign strictures of the extrahepatic bile ducts
Surgical trauma
Most common cause of extrinsic bile duct compression
Carcinoma of the pancreatic head
Organisms most commonly involved in Hepatobiliary Parasitism
Trematodes or flukes, including Clonorchis sinensis, Opisthorchis viverrini or O. felineus, Fasciola hepatica
Earliest lesion in Primary Biliary Cirrhosis (PBC)
Chronic nonsuppurative destructive cholangitis
Antibodies associated with PBC
Antimitochondrial antibodies (AMA)
Main symptoms of PBC
fatigue and pruritus
Only approved treatment for PBC
Ursodeoxycholic acid (UDCA) can slow the rate of progression of disease (but cannot reverse or cure)
Treatment of choice for decompensated cirrhosis due to PBC
Liver transplantation
Imaging technique of choice for the initial evaluation of Primary Sclerosing Cholangitis (PSC)
MRCP (but ERCP is the traditional gold standard diagnostic test)
Typical cholangiographic findings in PSC
Multifocal stricturing and beading involving both the intra and extrahepatic biliary tree
Ultimate treatment for PSC
Liver transplant
Dreaded complication of PSC
Development of cholangiocarcinoma
