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GI Week 4 > Lecture 38: Diseases of the Biliary Tree > Flashcards

Lecture 38: Diseases of the Biliary Tree Flashcards

1
Q

What are the complications of gallstones?

A
  1. Asymptomatic stone if in the gallbladder
  2. Stone intermittently obstructing cystic duct, causing intermittent biliary colic if it is at the mouth of the gallbladder
  3. Stone impacted in cystic duct, causing acute cholecystitis
  4. Stone in cystic duct compression common bile duct causing MIRIZZI syndrome
  5. Stone impacted in distal common bile duct, causing jaundice, biliary colic-type pain, and risk of ascending cholangitis or acute biliary pancreatitis
  6. Stone eroding through gallbladder into duodenum, resulting in cholecystenteric fistula
  7. . Long-standing cholelithiasis, resulting in gallbladder carcinoma
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2
Q

What is the epidemiology of gallstones?

A

8-10% of adult population

More females

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3
Q

What are the two types of gallstones?

A
  1. cholesterol stones
    • risks = the 4 F’s
  2. pigment stones
    • infection, cirrhosis and hemolytic anemia
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4
Q

What is cholelithiasis?

A

Gallbladder stones

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5
Q

Out of the adult population that has gallstones, how many are symptomatic?

A

10-20%

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6
Q

What is biliary colic?

A

Colic = a crampy pain that comes and goes
But this is actually a steady pain
-crescendos
-at the right upper quadrant or epigastric
Rapid onset, severe, steady pain
Radiation ot R shoulder or scapula
Remember that this is NOT RELIEVED by position change, antacids, flatus, etc.

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7
Q

What is the pathophysiology of biliary colic?

A

Pain is caused by gallstone that is wedged at the neck of the gallbladder and the junction of the cystic duct and hepatic ducts

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8
Q

When is CCK secreted?

A

When fatty food is ingested

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9
Q

What is suggestive of biliary colic?

A

Fatty food intolerance is suggestive

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10
Q

What are the characteristics of Acute cholecystitis?

A

An uncommon complication of cholelithiasis

Obstructed cystic duct + some other irritant factor that leads to inflammatory release

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11
Q

What is the classic presentation of acute cholecystitis?

A
  1. RUQ pain
  2. Fever
  3. Leukocytosis
    Is emergent because gallbladder can progress to risk of gangrene, perforation and sepsis
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12
Q

How do you diagnose acute cholecystitis?

A

Use HIDA radioscans
Radiolabeled technesium compound is injected to see where the bile is taken up (you will not see shit to go into the gallbladder if you have blocked cystic duct)

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13
Q

What is the pathophysiology of bacterial cholangitis?

A

Stasis due to biliary obstruction raises intrabiliary pressure
Intrabiliary pressure promotes migration and colonization nof bacteria from the portal circulation into the biliary tract

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14
Q

What is cholangitis?

A

Inflammation of the COMMON BILE DUCT ninjaaaa

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15
Q

What are the presentations of cholangitis?

A
  1. Charcot’s triad
    i. fever
    ii. RUQ pain
    ii. Jaundice
    Can progress to confusion and HYPOtension
    You don’t get jaundice unless you block the common bile duct
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16
Q

What is the treatment for bacterial cholangitis?

A

Antibiotics and duct clearance

17
Q

What is ERCP?

A

Endoscopic Retrograde CholangioPacreatography

Used to access biliary and pancreatic ducts for diagnostic AND therapeutic procedures

18
Q

What is better for diagnostic study?

A

MRCP rather than ERCP
MRCP has 0 risk of pancreatitis
ERCP may cause pancreatitis

19
Q

What are the characteristics of gallstone pancreatitis?

A

When the stone blocks the pancreatic duct
This makes pancreas become inflamed because the shit builds up in pancreas
Common cause of severe aucte pancreatitis
Need to ultimately have a cholecystectomy to prevent future complications

20
Q

What is the risk of pancreatitis with gallstones?

A

Small stones = higher risk

Bigger risks = smaller risk (cuz wont go through cystic duct)

21
Q

What is biliary sludge?

A

Mucoprotein and cholesterol cystals
Precursor of gallstones
Cause of indiopathic pancreatitis
Formed when stasis is present

22
Q

What are the types of biliary strictures (malignant)?

A
  1. pancreatic head carcinoma
  2. Cholangiocarcinoma (bile duct cancer)
  3. ampullary tumor
  4. Nodal compression
  5. Gallbladder carcinoma
23
Q

What is double duct sign?

A

When there are two ducts going into a mass (the common bile and pancreatic duct) and emerging from the other side of the mass
Indicative of pancreatic head carcinoma

24
Q

What are the types of benign biliary strictures?

A
  1. trauma
  2. postoperative
  3. post-liver transplant
  4. bile duct leaks
  5. chronic and pancreatitis
  6. PSC
25
Q

How do you prevent a bile leak?

A

By putting in a stent that opens the sphinter of Oddi and reverse pressure gradient so less flows into the small intestin

26
Q

By putting in a stent that opens the sphinter of Oddi and reverse pressure gradient so less flows into the small intestine

A

Associated with IBD (UC>CD)

-inflammation of the common bile duct, fibrosis, structuring

27
Q

What are the genetics of PSC?

A

HLA-B8

28
Q

What are the immunological characteristics of PSC?

A

P-ANCA is often found

29
Q

What are the symptoms of PSC?

A

Abnormal LAEs (cholestatic)
Fatigue, pruritus, fever, RUQ pain
ONION SKINNING

30
Q

What is choledocolithiasis?

A

Gallstones in the bile duct

31
Q

What are the key points about choledocolithiasis?

A

should be cleared ideally with ERCP due to risk of complications (cholangitis, biliary pancreatitis…these complications refer to complications of disease not ERCP

32
Q

What are the potential complications of gallstones?

A

i. cholecystitis (cystic duct obstruction, requires urgent attention, cholecystectomy)
ii. cholangitis (bacterial infection of the bile duct due to lodged stone, medical emergency, antibiotics and ERCP
iii. Biliary pancreatitis (ampullary stone causing transient obstruction of PD, CysticBileDuct must ultimately be cleared as well)

33
Q

What is the treatment for cholangitis?

A

Cholycystectomy should follow an episode of cholangitis or biliary pancreatitis to prevent future complications

34
Q

What are the key points for Primary Sclerosing Cholangitis?

A

A. Progressive cholestatic biliary STRICTURING disease with classic appearance on cholangiography (alternating areas of stricture and dilation)
B. Has an association with IBD
C. Increased risk of bile duct cancer (cholangiocarcinoma)
D. Can lead to cirrhosis (end stage liver disease) requiring liver transplant
E. biliary strictures and episodes of cholangitis can be treated endoscopically

GI Week 4 (12 decks)

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