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G2F > Jaundice and Biliary Disorders DSA > Flashcards

Jaundice and Biliary Disorders DSA Flashcards

1
Q

Jaundice- essentials of diagnosis

A
  • jaundice results from accum of bilirubin in body tissues; the cause may be hepatic or nonhepatic
  • hyperbilirubinemia- may be due to abnormalities in the formation, transport, metabolism, or excretion of bilirubin
  • persistent mild elevations of aminotransferase levels- most often caused by NAFLD
  • evaluation of obstructive jaundice- begins with ultrasonography, and followed by cholangiography
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2
Q

Unconjugated hyperbilirubinemia- causes

A
  • inc bilirubin production (hemolytic anemias)

- impaired bilirubin uptake and storage (gilbert syndrome, Crigler-Najjar syndrome)

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3
Q

Conjugated hyperbilirubinemia- causes

A
  • hereditary cholestatic syndromes
  • hepatocellular dysfxn
  • biliary obstruction
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4
Q

Gilbert syndrome- cause? type of hyperbilirubinemia, clinical characteristics

A
  • reduced activity of uridine diphosphate glucuronyl transferase
  • unconjugated bilirubin
  • benign, asymptomatic jaundice
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5
Q

Dubin-Johnson syndrome- cause? type of hyperbilirubinemia, clinical characteristics

A
  • reduced excretory fxn of hepatocytes
  • conjugated bilirubin
  • gallbladder doesnt visualize on oral cholecystography
  • liver darkly pigmented!!!
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6
Q

Rotor syndrome- cause? type of hyperbilirubinemia, clinical characteristics

A
  • reduced hepatic reuptake of bilirubin conjugates
  • conjugated bilirubin
  • liver isnt pigmened and gallbladder visualized on oral cholecystography
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7
Q

recurrent intrahepatic cholestasis- cause? type of hyperbilirubinemia, clinical characteristics

A
  • cholestasis
  • conjugated bilirubin
  • jaundice, itching, malaise
  • alk phos inc
  • cholestasis- liver biopsy
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8
Q

intrahepatic cholestasis of pregnancy- cause? type of hyperbilirubinemia, clinical characteristics

A
  • cholestasis
  • conjugated bilirubin
  • jaundice- 3rd trimester of pregnancy
  • recurrence with use of oral contraceptives and subsequent pregnancies
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9
Q

symptomatic gallstones- clinical features, lab, diagnosis, teratment

A
  • biliary pain
  • normal
  • ultrasonography
  • laparoscopic cholecystectomy
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10
Q

acute cholecystitis- clinical features, lab, diagnosis, teratment

A
  • epigastric or RUQ pain, N/V, fever, murphy sign
  • leukocytosis
  • ultrasonography, HIDA scan
  • antibiotics, laparoscopic cholecystectomy
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11
Q

choledocholithiasis

A

(common bile duct stone)

  • asymptomatic or biliary pain, jaundice, fever
  • cholestatic liver tests; leukocytosis andp ositive blood cultures in cholangitis; elevated amylase and lipase in pancreatitis
  • ultrasonography, EUS, MRCP, ERCP
  • endoscopic sphincterotomy and stone extraction
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12
Q

Acute Cholecystitis- essentials of diagnosis

A
  • steady, severe pain and tenderness in right hypochondrium or epigastrium
  • N/V
  • fever and leukocytosis
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13
Q

Cholecystitis- caused by

A

-stone in cystic duct and infl develops

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14
Q

Cholecystitis- sx

A
  • attack precipitated by a large/fatty meal- steady pain
  • vomiting
  • fever
  • RUQ tenderness, Murphy sign, m guarding, rebound tenderness
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15
Q

Cholecystitis- lab findings

A
  • WBC high

- aminotransferase and alk phos- elevated

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16
Q

cholecystitis- imaging

A

-HIDA scan- for obstructed cystic duct

17
Q

acute cholecystitis- complications

A

gangrene of the gallbladder

-emphysematous cholecystitis (secondary infection with gas forming organism)

18
Q

Choledocholithiasis and cholangitis- essentials of diagnosis

A

(common bile duct stones)

  • history of biliary pain
  • painless jaundice sometimes
  • N/V
  • cholangitis should be suspected with fever
  • stones in bile duct detected by ERCP or EUS!
19
Q

bile duct stone- sx

A
  • freq recurring attacks of RUQ abd pain- severe, lasts for hrs
  • chills and fever
  • hx of jaundice
20
Q

acute cholangitis- ssx

A

-pain, fever, jaundice- Charcot triad!!!

21
Q

Reynolds pentad

A 
Charcot triad (pain, fever, jaundice) + altered mental status and hypotension
-suppurative cholangitis- emergency
22
Q

choledocholithiasis- lab findings

A
  • inc in serum aminotransferase levels
  • elevation of serum bilirubin
  • secondary pancreatitis- amylase elevations
23
Q

choledocholithiasis- imaging

A

-ERCP- determines cause, location, extent of obstruction

24
Q

Primary Sclerosing Cholangitis- essentials of diagnosis

A
  • most common in men ages 20-50
  • assoc with UC
  • progressive jaundice, itching, cholestasis features
  • diagnosis- characteristic cholangiographic findings
  • 10% risk of cholangiocarcinoma
25
Q

PSC- dec risk

A
  • smoking in pts who haeve IBD

- coffee

26
Q

PSC- diagnostic findings

A
  • MRCP
  • segmental fibrosis of bile ducts with saccular dilatations b/w strictures
  • liver biopsy- periductal fibrosis (onion skinning)
27
Q

PSC- complicatoins

A

cholangiocarcinoma

-CA 19-9 level- suggestive but not diagnostic

G2F (17 decks)

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