Jaundice and Biliary Disorders CIS

Question 1

Gilbert’s syndrome

Answer 1

• reduced activity of urine diphosphate glucuronyl transferase
• unconjugated bilirubin

Question 2

Rotor syndrome

Answer 2

-reduced hepatic reuptake of conjugated bilirubin

Question 3

Dubin johnson

Answer 3

• reduced excretory fxn of hepatocytes

- darkly pigmented liver!!

Question 4

pancreatic cancer- sx

Answer 4

painless jaundice!!

Question 5

Cholelithiasis -inc risk?

Answer 5

(gallstones)

-rapid weight loss, indian, diabetes

Question 6

Cholelithasis- dec risk?

Answer 6

-low carb diet, exercise, coffee

Question 7

porcelain gallbladder- risk for?

Answer 7

gallbladder cancer

usually seen incidentally

Question 8

emphysematous gallbladder

Answer 8

-bacterial infection with Clostridium perfringens

Question 9

cholecystitis- stone where?

Answer 9

cystic duct!!

Question 10

Choledocholithiasis- stones where?

Answer 10

common bile duct

-risk factor for asc cholangitis!!

Question 11

Asc cholangitis- most common cause?

Answer 11

common bile duct stone (choledocholithiasis)

Question 12

Asc cholangitis- next step?

Answer 12

emergent ERCP!! (endoscopic retrograde cholangiopancreatography)

Question 13

gallbladder- Somatic dysfxn

Answer 13

-T5-7 on right

Question 14

Cholesterolosis

Answer 14

“strawberry gallbladder”

-accum of cholesterol

Question 15

Jaundice- clinically seen when?

Answer 15

bilirubin > 3 mg/dL!!! (normal 0.2-1.2)

• M > F
• caucasian, hispanic > Af Am

Question 16

Gallstones- risk factors

Answer 16

-female
-inc age
-american indians
-obesity
-rapid weightl oss
-DM
-high intake of carbs
-oral contraceptives
(F- Family hx, fair, fat, female, fertile, forty)

Question 17

Gallstones- protective

Answer 17

• low carb diet
• physical activity
• cardioresp fitness
• coffee
• high intake of Mg and polyunsaturated fats
• high fiber diet
• ASA, NSAIDs

Question 18

Acute cholecystitis- US findings

Answer 18

-GB wall thickening, pericholecystic fluid, sonographic murphy sign

Question 19

Acute cholecystitis- complications

Answer 19

-perforation, gangrene, abscess, peritonitis, emphysematous cholecystitis

Question 20

Choledocholithiasis- imaging

Answer 20

(common bile duct stone)
-best seen ERCP or EUS
(complication of ERCP- iatrogenic pancreatitis)
-bile duct diameter > 6 mm!!

Question 21

porcelain GB

Answer 21

• manifestation of chronic cholecystitis
• intramural calcification of GB wall
• dx- abd radiography- incidental calcified lesion!!!
• asymptomatic often
• inc risk of gallbladder carcinoma!!!

Question 22

Asc cholangitis- sx

Answer 22

-Charcot’s triad- jaundice, fever, RUQ pain

Question 23

Reynold’s pentad

Answer 23

• Charcot’s triad + hypotension and confusion

- asc cholangitis!!!

Question 24

Primary Sclerosing Cholangitis- imaging

Answer 24

• ERCP/MRCP- “beads on a string”

- liver bx- “onion skinning”

Question 25

PSC

Answer 25

• men (20-50 yo)
• UC!
• inc risk of cholangiocarcinoma
• smoking- dec risk of UC and PSC
• coffee- dec risk
• HLA-B8 and DR3/4
• ANCA+
• Dx- MRCP or ERCP!!