Jaundice and Biliary - McGowan

Question 1

Elevated Unconjugated bili is due to impaired bilirubinuptake and storage. Diseases associate with it include:

Answer 1

• Posthepatitis
• Gilbert syndrome
• Crigler-Najjar syndrome
• Drug reaction

Question 2

Elevated conjugated bili can be due to impaired excretion. Diseases associated with it includes

Answer 2

• Dubin-johnson
• rotor syndrome
• Familial or benign recurrent intrahepatic cholestasis

Question 3

In terms of serum bili concenration, differentiate Criglar najjar I, II and gilbert.

Progonosis for these three

Answer 3

Crigler-Najjar I: 20-50 (Kernicterus, unless treated)
Crigler-Najjar II: <20 (usually benign, kernicterus rarely)
Gilbert: <3 (benign)

Question 4

Acute cholecystitis US findings

Answer 4

GB wall thickening, pericholecystic fluid, and sonographic murphy sign

Question 5

Best imaging modality for choledocholithiasis

Answer 5

ERCP, diagnostic and therapeutic. Complication: Iatroenic pancreatitis

Bile duct greater than 5mm on imaging

Question 6

Uncommon manifestation of chronic cholecystitis that can lead to gallbladder carciinoma

Answer 6

Porcelain GB - intramural calcification of gallbladder wall

Question 7

Primary scleorisng cholangitis: characteristic ERCP finding; and liver biopsy finding

Answer 7

ERCP: beads on a string
Bx: onion skinning

Question 8

A 30 yr old well controlled ulcerative colitis presents with onset of jaundice, fever, and RUQ pain. Pt shown to have beads on a string appearance on a ERCP.
A. what neoplasm is at increased risk of?
B. what HLA is associated
C. what’s known to decrease risk?
D. Common complication

Answer 8

Pt is presenting with PSC
A. Cholangiocarcinoma
B. B8 and DR3 or DR4
C. drinking coffee
D. osteoporosis and malabsorption of fat soluble vitamins, esophageal varices

Question 9

PBC or PSC?

female, Sjogren, sclerodoerma, AMA, ANA, ANCA positivity, Florid duct lesions

Answer 9

PBC

Question 10

PBC or PSC?
Male, IBD, pancreatitis, ANCA positivity, strictures and beading or large bile ducts, destruction of extrahepatic and large intrahepatic ducts

Answer 10

PSC

Question 11

Pt with recent small bowel surgery and NPO for about 7 days, presents suddenly with steady pain in the RUQ, N/V and a fever. RUQ is TTP and positive Murphy. What is the most likely diagnosis?

Answer 11

Acalculous cholecystitits.

Calculous cholesystitis would present after a large or fatty meal

Question 12

Very Strong predictor of choledocholithiasis includes

Answer 12

• US evidence of CBD stone (ductal dilation)
• Clinical signs of ascending cholangitis
• Elevated bilirubin (> 4)