Lecture 6 - Biliary Tract Disease

Question 1

gall stones:

due to increased ___ or ____, decreased ____, and/or gall bladder _____

Answer 1

cholesterol, bilirubin;
bile salts;
stasis

Question 2

primary sclerosing cholangitis:
unknown cause of _____ ____ of bile duct;
asscoiated with _____ (another disease) and ____ (on lab

Answer 2

concentric fibrosis (onion skin);
ulcerative colitis;
p-ANCA

Question 3

primary biliary cholangitis:

____ reaction characterized by ____ infiltrate and ____ –>destruction of ____ bile ducts

Answer 3

autoimmune;
lymphocytic, granulomas;
intralobular

Question 4

primary biliary cholangitis:
classically seen in who?
_____ on lab

Answer 4

middle-aged women;

anti-mitochondrial AB

Question 5

biliary tract disease:
pruritis due to \_\_\_\_;
\_\_\_\_ jaundice (increased \_\_\_\_ on lab);
\_\_\_\_ colored stool
\_\_\_\_ urine

Answer 5

bile salt deposition;
obstructive, conjugated bili;
pale;
dark

Question 6

gallstones - chol vs bili:
most common overall?
yellow in color?
black or brown in color?

Answer 6

chol;
chol;
bili

Question 7

gallstones chol vs bili:
usually radiolucent =
typically radioopaque =

Answer 7

cholesterol;

bili

Question 8

gallstones chol vs bili associations:
chronic hemolysis = 
Total parenteral nutrition = 
obesity = 
rapid weight loss = 
estrogen therapy =

Answer 8

bili;
bili;
chol;
chol;
chol

Question 9

classic risk factors of gall stones (4 F’s)

Answer 9

female, fat, fertile (pregnant), forty

Question 10

choledocholithiasis is presence of gallstones in the _____. can lead to elevated ____, GGT, ____ bilirubin and may cause ___ _____

Answer 10

common bile duct;
ALP;
conjugated/direct;
ascending cholangitis

Question 11

acute cholescytitis:
usually due to gallstone ____ in the _____ ____ Resulting in inflammation, can precipitate infection with ____ usually.
lab findings: ____ temperature, ____ WBC, normal or increased ALP?

Answer 11

impaction, cystic duct;
E. coli;
increased;
increased;
increased

Question 12

cholecystitis:
what is murphy’s sign?
pain is localized ____ and clasically radiates where?

Answer 12

inspiratory arrest on RUQ palpation due to pain;

in RUQ, right scapula

Question 13

gallstone illeus:

fistula between gallbladder and ____ –> air in ____ and obstruction at _____

Answer 13

duodenum;
biliary tree;
ileocecal valve

Question 14

charcot triad of ascending cholangitis

Answer 14

jaundice, fever (From sepsis), RUQ pain

Question 15

biliary colic:

classically occurs following a ____ meal due to increased _____ –>contraction of gb forcing stone into _____

Answer 15

fatty, CCK;

cystic duct

Question 16

biliary colic vs acute cholecystitis:
which pain lasts longer?
which patients have fever?q

Answer 16

cholecystitis;

cholecystitis

Question 17

gallstone risk factors:
which lipid-lowering agent can cause gallstones?
what ethnicity has increased risk?

Answer 17

fibrates (bile acid resins may as well);

native americans

Question 18

imaging of choice for gallstones?

Answer 18

ultrasounds

Question 19

HIDA scan:

failure to visualize GB on scan sugests what

Answer 19

obstruction of cystic or common bile duct

liver takes up IDA, excretes it into bile

Question 20

Endoscopic retrograde cholangiopancreatography (ECRP) involves contrast material injected in a ____ approach from the _____

Answer 20

retrograde, duodenum

Question 21

PTC involves ____ injection of contrast material into the ____

Answer 21

percutaneous;

gall bladder

Question 22

gallbladder stone treatment:

stones should be removed surgically if they are ____. pain is controlled with ____ as a first choice

Answer 22

symptomatic;

ketorolac

Question 23

_____ ____ ____ can be administered to dissolve the stones, although there is a high recurrence rate

Answer 23

hydrophobic bile acids

Question 24

most common complication of gall bladder surgery?

Answer 24

diarrhea