Jandice and Biliary disorders CIS Flashcards
unconjugated bilirubenemia disease that is usually greater than 20
Crigler-Najjar syndrome
reduced activity of uridine diphosphate glucournyl transferase is _____ and total bilirubin is usually around __
gilberts syndrome
3 when fasting
acutley ill
reduced excretory function of hepatocytes
dubin johnson
hyperpigmentation of the liver
reduced hepatic reuptake of bilirubin
rotor syndrome
stone in the common bile duct is ____ what would be seen on ultrasound
choledocholithiasis
would see common bile duct dilation
painless jaundice and mass
pancreatic cancer
rapid weight loss or weight gain is a risk factor for gallstones
weight loss
risk factor for emphysematious gallbladder
uncontrolled diabetic
bacterial infection with C perfringes
-findings–> positive murphys sign, rebound and guarding
most common location for cholycystitis
cystic duct
what is mareasy syndrome
stone in the cystic duct but it is pushing on the hepatic duct
would have increased liver enzymes
choledocholithiasis lab values
change in AST, ALT, alk phos, bilirubin
lipase could be elevated bc right by pancreatic duct opening
if you know that you have ascending cholangitis from choledocholithiasis then what is the treatment
emergent ERCP bc this is therapeutic and diagnostic
-would actually start antibiotics first
what is cholesterolosis
strawberry gallbladder
lipid laden macrophages, asymptomatic
what is hydrops of the gallbladder
chronic obstruction of the cystic duct that leads to resorption of normal GB contents that produces large amt of fluid
someone with UC and jaundice is at risk for getting
cholangiocarcinoma
when is clinical jaundice seen
bilirubin at or above 3
what is normal bilirubin
0.2-1.2
serum bilirbuin concentration in crigler naijar syndrome type 1, type 2, and gilbert’s syndrome
type 1: usually less that 20-50 mg.dL
type 2: usually less than 20
Gilbert: usually less than 3
protective or risk factor for gallstone
-high intake of mg and polyunsaturead and monounsaturated fats in men
protective
protective or risk factor for gallstone
-higher fiber diet and statins
protective
protective or risk factor for gallstone
-ASA and NSAIDs
protective
protective or risk factor for gallstone
-rapid weight loss
risk factor
protective or risk factor for gallstone
-prolonged fasting
risk factor
protective or risk factor for gallstone
-OCs and pregnancy
risk factor
protective or risk factor for gallstone
-chrons disease
risk factor
protective or risk factor for gallstone
-low carb diet
protective
ultrasound finding of acute cholecystitis
GB wall thickening
pericholecystic fluid
sonographic murphy sign
CT may show acute cholecysitis but has complications
perforation gangrene abscess peritonitis emphysematious cholecystics
choledocholithiasis and bile duct diameter
best seen on what
greater than 6mm on imaging
ERCP and EUS
porcelain GB from
uncommon manifestation of chronic cholecystitis
- incidental calcified lesion in region of GB
- often asymptomatic
- incresaed risk for development of GB cancer (poor prognosis)
treatment for ascending cholangitiis
ampicillin-sulbactam
ticarcillin-CA
pipercilin-tazobactam
or ceftriaxone nad metronidazole
or fluoroquinoline plus metronizale
or monotherapy with carbapenem
primary sclerosing cholangitis seen with what imaging and looks like what. what do you see on liver biopsy
ERCP/MRCP–> beads on a string
Liver biopsy: onion skinning
what is PSC associated with what diseases risk of what HLA types other things decrease risk with age and sex
UC CVD and DM risk of cholangiocarcinoma HLA-B8 and DR3 or DR4 malabsorption of ADEK esophageal varics decrease risk with coffee consumption males 20-50
PBC associated conditions
sjogren syndrome
thyroid disease
scleroderma
PBC antibodies
AMA positive
PSC antibodies
ANCA positive 65% of time
