Jaundic And Biliary Disorders CIS Flashcards
Dublin Johnson syndrome
You get the really black liver
- normal AST/ALT and CBC
- galbladder wall thickening
What will predispose a pregnant lady who is having cholecystitis to recurrence of symptoms?
Taking oral contraceptives
Which blood will give you hyperbilirubinemia?
Sickle cell anemia
-more destruction of RBC’s
Faulty excretion of bilirubin
Dublin Johnson
Impaired bilirubin storage
Gilbert’s
-the intense one is criggler Najjar
Charcot’s triad
For ascending cholangitis
- jaundice
- fever
- RUQ pain
Which one is a painless jaundice… They show up and they’re yellow and they don’t know why?
Pancreatic cancer!
“Shock liver”
Ischemic hepatitis
-they will be REALLY sick
Episodic RUQ pain
Think choledocalithiasis
-diabetes is a risk factor for gallstone production
If you see a porcelain gallbladder, what should we worry about
Fucking cancer!
What is emphysematous gallbladder
Air around the gallbladder
- in uncontrolled diabetics
- bacterial infection with Th gas-forming organism: C. Perfringes
Where do stones get lodged when it hurts like hell in the gallbladder?
The cystic duct!
In alcoholic pancreatitis, which is higher, AST or ALT?
AST
-that’s why it’s the weird one
What is primary sclerosing cholangitis associated with?
Ulcerative colitis
-remember the pANCA
In choledocalithiasis, what pancreatic enzyme is elevated?
Lipase
-stone in the common bile duct…. Backs EVERYTHING up
What is ERCP
Endoscopic retrograde cholangiopancreatograhy
What is MRCP
Magnetic retrograde cholangiopancreatograhy
Where will we have a somatic dyfunction in gallbladder disease
T5-7
What gives you a strawberry gallbladder?
Cholesterolosis
What is porcelain gallbladder
From chronic cholecystitis
-increased risk of gallbladder cancer
What are the 2 kinds of jaundice you can have?
Unconjugated or conjugated
Indirect vs. direct bilirubin
indirect is unconjungated
direct is conjugated
What are the 2 caused of unconjugated jaundice?
- increase bilirubin production
- impaired bilirubin uptake and storage
what can result from increased bilirubin production?
hemolysis
hematoma
What can result from impaired bilirubin uptake and storage?
- posthepatitis
- Gilbert syndrome
- Crigler-Najjar syndrome
- drug reaction
What are the 3 causes of conjugated jaundice?
- impaired excretion
- hepatocellular dysfunction
- biliary obstruction
What can happen with impaired excretion?
Dubin johnson
rotor syndrome
choestasis
what can happen with hepatocellular dysfunction?
hepatitis/cirrhosis
-infection
What can happen with biliary obstruction?
- choledocholithiasis
- biliary atresia
- pancreatitis
- carcinoma of bile duct or pancreas
At what level of bilirubin is clinical jaundice seen?
> or = 3
- hemolysis alone rarely elevates bilirubin
- white people and mexicans
What is ERCP and where does it go?
Endoscopic Retrograde Cholangiopancreatography
- down through the stomach into the proximal duodenum
- then, a thing comes out that goes into the sphincter of oddi the other way and up the common bile duct
What is MRCP?
Magnetic resonance cholangiopancreatography
-it looks like an xray with contrast…
What is EUS?
endoscopic ultrasound
What will galltones show on Ultrasound?
and ACOUSTIC SHADOW
What are some risk factors for gallstones?
female
- old
- fat
- DM
- crohn disease… pigment stones
- oral contraceptives
- Fair, Fat, female, fertile, forty?, family hx
What are some protective factors for gallstones?
- low carb
- active
- COFFEE!
- ASA and NSAIDs
Acute Cholecystitis
GB wall thickening, pericholecystic fluid, and a sonographic murphy sign
complicates of cholecystitis
Perforation, gangrene, abscess, peritonitis, emphysematous choecystitis
Choledocholithiasis
common bile duct stone
- best seen on ERCP or EUS
- can possibly see on US, CT
- Can see on MRCP, but usually go on to ERCP since diagnostic and therapeutic
What is a potential complication of ERCP?
iatrogenic pancreatitis
What was that thing she had in bold on the choledocholithiasis slide?
Bile duct diameter greater than 6mm imaging
What does a Porcelain Gallbladder mean?
increased risk for development of gallbladder carcinoma, which has a poor prognosis
-incidental calcified lesion… usually asymptomatic
What is Charcot’s triad
it means ascending cholangitis
- Jaundice
- Fever
- RUQ pain
What can cause/ what is reynold’s pentad?
the presence of pus in the biliary ducts
-Charcot’s triad plus hypotension and confusion
What does primary sclerosing cholangitis show on ERCP and MRCP and what does the liver biopsy look like?
- beads on a string
- onion skinning
What is PSC associated with?
men
- UC!!!!
- increased risk of cholangiocarcinoma
- same for colon cancer (from UC)
- malabsorption of ADEK, esophageal varices, osteoporosis
dx PSC
MRCP or ERCP
