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GI II Exam 2 > Lecture 4 - Jaundice and GB Disorders > Flashcards

Lecture 4 - Jaundice and GB Disorders Flashcards

1
Q

Impaired bilirubin excretion, Hepatocellular dysfunction, and Biliary Obstruction are all causes of jaundice due to increased levels of what type of bilirubin?

A

Conjugated (direct)

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2
Q

What is the defect in Rotor Syndrome?

What type of hyperbilirubinemia?

A
  • Reduced hepatic reuptake of bilirubin conjuagtes
  • Conjugated (direct) hyperbilirubinemia
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3
Q

Intrahepatic cholestasis of pregnancy is associated with what type of hyperbilirubinemia?

A

Conjugated (direct)

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4
Q

Intrahepatic cholestasis of pregnancy typically occurs during what trimester and with what symptoms?

A
  • Third
  • Itching, GI symptoms, and abnormal liver excretory function tests
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5
Q

Hemolysis, hematomas, and hemolytic anemias can lead to what type of hyperbilirubinemia?

A

Unconjugated (indirect)

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6
Q

Phenobarbital will reduce serum bilirubin in what 2 disorders of unconjugated hyperbilirubinemia?

A
  1. Crigler-Najjar Type 2
  2. Gilbert’s syndrome
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7
Q

Posthepatitis hyperbilirubinemia is due to impaired?

Increased levels of what type of bilirubin?

A
  • Impaired bilirubin uptake and storage
  • Unconjugated (indirect) hyperbilirubinemia
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8
Q

Hepatocellular dysfunction (i.e., hepatitis/cirrhosis, drugs/biliary cirrhosis/sepsis, infection/cholangitis/sarcoidosis and lymphoma) is associated with increased levels of what type of bilirubin?

A

Conjugated (direct)

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9
Q

You can fractionate AlkPhos by ordering GGT, and if the GGT is elevated the most common source of the jaundice is from where?

A

Liver

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10
Q

Diagnosis of obstructive jaundice (conjugated) typically begins with what type of imaging modality?

Can be followed by?

A
  • Ultrasound = first
  • Followed by cholangiography
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11
Q

Cholestatic disease is when the primary injury occurs where?

Which labs elevated?

A
  • Bile ducts
  • AlkPhos and bilirubin = elevated
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12
Q

What are 8 causes of severe elevations in serum transaminases (>15x normal)?

A
  1. Acute viral hepatitis (A-E, herpes)
  2. Medications/toxins
  3. Ischemic hepatitis
  4. Autoimmune hepatitis
  5. Wilson disease
  6. Acute bile duct obstruction
  7. Acute Budd-Chiari syndrome
  8. Hepatic artery ligation
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13
Q

Persistent mild elevation of aminotransferase levels (ALT and AST) are common in clinical practice and most often caused by?

A

NAFLD

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14
Q

Acute cholecystitis is associated with what lab finding?

A

Leukocytosis

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15
Q

Biliary dyskinesia presents with what symptom complex?

A
  • Episodes of RUQ pain
  • Severe pain that limits activities of daily living
  • Nausea associated w/ episodes of pain
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16
Q

Biliary dyskinesia presents clinically with RUQ pain that is similar to?

A

Biliary Colic

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17
Q

For patients who are suspected to have Biliary Dyskinesia, which diagnostic criteria should be considered?

A

Rome III diagnostic criteria for functional GB disorders

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18
Q

What are the ultrasound and liver enzyme, conjugated bilirubin, and amylase/lipase levels like in Biliary Dyskinesia?

A

All NORMAL

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19
Q

What is considered a normal HIDA scan of the GB?

A

GB visualized within 1 hour of injection, tracer also seen in small bowel

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20
Q

What is considered an abnormal HIDA scan?

A

GB not seen –> stone in cystic duct or cholecystitis

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21
Q

A CCK-HIDA scan looks at ejection fraction and what is considered an abnormal ejection fraction %?

Associated with what disorder?

A
  • Abnormal ejection fraction = <35-38%
  • Choleycystectomy
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22
Q

Diagnosis of Choledocholithiasis can be made with what imaging modalities?

Which specifically visualizes dilated ducts?

A
  • Ultrasound/CT (dilated ducts)
  • EUS
  • MRCP
  • ERCP
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23
Q

What is a protective factor for gallstones in women?

In men?

A
  • Consumption of caffeinated coffee –> Women
  • High intake of Mg and poly-/monounsaturated fats –> Men
24
Q

Chron disease is a risk factor what what type of gallstones?

A

Pigment stones

25
Q

What are the major symptoms of Cholelithiasis?

A

1) Biliary colic = severe steady ache in RUQ or epigastrium that begins suddenely; often occurs 30-90 mins after meal, occasionally radiates –> right scapula or back
2) N/V

26
Q

What is the best diagnostic imaging test for Cholelithiasis?

What would you expect to see?

A
  • Ultrasonography
  • Stones seen as well as an “acoustic shadow” that they cast
27
Q

What are essential findings in the diagnosis of Acute Cholecystitis?

A
  • Steady, severe pain
  • Tenderness in the RUQ or epigastrium
  • N/V
  • Fever and leukocytosis
28
Q

Acute Calculous Cholecystitis is caused by gallstones lodged where?

Where does the inflammation develop?

A
  • Cystic duct
  • Inflammation of GB develops behind the obstruction
29
Q

Is Acute Acalculous Cholecystitis a true cholecystitis?

How does this occur?

A
  • True cholecystitis + no stones
  • Due to acute illness (i.e., burns or major surgery), fasting, carcinoma of GB, or infections of GB
30
Q

Acute Cholecystitis often occurs after?

What are the signs/symptoms?

A
  • Large fatty meal –> acute attack
  • Epigastric/RUQ tenderness (often w/ Murphy Sign)
  • Muscle guarding and rebound tenderness
  • Sometimes palpable gallbladder
31
Q

What are the 5 relevant elevated labs for Acute Cholecystitis?

A

1) Leukocytosis
2) Bilirubinemia
3) Serum AST
4) AlkPhos and GGT
5) Serum amylase

32
Q

Plan film (XR) of the abdomen in a pt w/ Acute Cholecystitis may show?

A

Radiopaque gallstones

33
Q

99Tc hepatobiliary imaging (aka HIDA scan) of pt w/ Acute Cholecystitis is used to demonstrate what?

A

Obstructed (cystic) duct

34
Q

Which findings on abdominal ultrasonography are suggestive of Acute Cholecystitis?

A
  • GB wall thickening
  • Pericholecystic fluid
  • Sonographic Murphy sign
35
Q

Gangrene of the GB is a possible complication of Acute Cholecystitis and may lead to what further complications?

A

GB perforation usually w/ formation of pericholecystic abscess and rarely to generalized peritonitis

36
Q

Choledocholithiasis is due to an obstruction by stones where?

A

Common bile duct (CBD)

37
Q

Obstructions in the common bile duct are most reliably detected with which 2 imaging modalities?

A
  1. ERCP
  2. EUS
38
Q

If a patient presents with signs/symptoms of acute cholecystitis but they have jaundice what does this suggest?

A

Possible Choledocholithiasis

39
Q

What is the procedure of choice for Choledocholithiasis?

A

- ERCP w/ sphincterotomy and stone extraction or stent placement

  • Then laparoscopic cholecystectomy
40
Q

Choledocholithiasis can lead to what complication?

A

Acute ascending cholangitis (AC)

41
Q

What is the Charcot Triad of Ascending Cholangitis?

A

RUQ pain + Fever (and chills) + Jaundice

42
Q

What is the Reynold Pentad of Ascending Cholangitis?

A
  • Charcot Triad
  • Altered mental status (confusion)
  • Hypotension
43
Q

Appearance of the Reynold Pentad in ascending cholangitis signifies what and why is it significant?

A

Acute suppurative cholangitis = endoscopic EMERGENCY!

44
Q

What is Murphy’s Sign?

A

Present when deep inspiration or cough during palpation of the RUQ produces increased pain or inspiratory arrest

45
Q

Choledocholithiasis has similar signs and symptoms as Ascending Cholangitis, which lab value can help determine that the problem is in fact Ascending Cholangitis?

A

Leukocytosis

46
Q

Which imaging modality is preferred for Chronic Cholecystitis?

Usually shows what?

A

Ultrasonography –> stones within a contracted GB

47
Q

Chronic Cholecystitis is often what for years?

A

Asymptomatic

48
Q

Complications of Chornic Cholecystitis?

A

Porcelain GB

49
Q

How is the the Porcelain GB seen in Chronic Cholecystitis often discovered?

A

Most likely on plain XR –> showing an incidental calcified lesion

50
Q

What is the significance in prognosis of finding a porcelain GB?

A

Risk of GB cancer (poor prognosis)

51
Q

What is the procedure of choice for most patients undergoing elective cholecystectomy for cholelithiasis?

A

Laparoscopic cholecystectomy

52
Q

What are the mainstays of treatment for Acute Cholecystitis?

A
  • No oral intake (NPO)
  • Nasogastric suction
  • IV fluids and electrolytes
  • Analgesia (meperidine or NSAIDs)
  • Antibiotics
  • Surgery (as soon as pt stabilized)
53
Q

In pts with a suspected or confirmed complication associated with acute cholecystitis what is the treatment?

A

Urgent cholecystectomy

54
Q

How is cholangitis treated?

A
  • Treat like acute cholecystitis
  • No PO, hydrate, analgesia, and antibiotics
  • Stones should be removed surgically or endoscopically
55
Q

What is the treatment of Primary Sclerosis Cholangitis (PSC)?

A
  • No satisfactory therapy
  • Cholestyramine may control pruritus
  • Liver transplantation considered in pts w/ end-stage cirrhosis

GI II Exam 2 (15 decks)

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