Pathophysiology of gallbladder and bile duct Flashcards

1
Q

function of gallbladder

A

store/concentrate bile (fasting), contracts to deliver bile to duodenum (fed)

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2
Q

function of sphincter of Oddi

A

conserve bile, prevention of biliary infection (cholangitis)

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3
Q

manifestations of gallstones

A

most are asymptomatic. can lead to biliary colic, acute cholecystitis, obstructed common bile duct, pancreatitis

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4
Q

most common gallstone. soft, greasy, white yellow

A

cholesterol stone

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5
Q

black, hard, brittle stones. associated with bile stasis

A

pigment stones

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6
Q

least common stones. associated with bacterial colonization

A

brown stones

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7
Q

cholesterol lithogenesis

A

cholesterol supersaturation, phospholipid deficiency, stasis, inflammation, overabsorption of water in gallbladder

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8
Q

chief constituent of pigment stones

A

calcium bilirubinate

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9
Q

risk factors for pigment stones

A

bile duct obstruction, excess bilirubin excretion (hemolysis), east Asian ancestry, parasitic infection

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10
Q

risk factors for gallstones

A

(5 F’s) fat, fertile, 40yo female with family history

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11
Q

pain in epigastrium or RUQ, relapse/remit with food/fast

A

biliary colic

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12
Q

management of biliary colic

A

cholecystectomy, nonlithogenic bile acid supplement (ursodeoxycholic acid)

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13
Q

Presentation: severe RUQ, nausea, FEVER

stone impaction in cystic duct or gallbladder neck –> bacterial colonization (GNRs, enterococci)
transmural inflammation, distention, ischemia

A

acute calculous cholecystitis

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14
Q

treatment of acute calculous cholecystitis

A

NPO (gallbladder rest), IV hydration, IV abx, cholecystectomy

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15
Q

due to gallbladder ischemia. associated with sepsis, recent surgery, trauma/burns, hypotension

similar symptoms to acute calculous cholecystitis

A

acalcuous cholecystitis

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16
Q

treatment of acalculous cholecystitis

A

percutaneous drainage of gallbladder, cholecystectomy

17
Q

Presentation: jaundice, dark urine, abd pain, acute pancreatitis

A

choledocholithiasis

18
Q

diagnosis of choledocholithiasis

A

liver chemistries, ultrasound, MRCP/ERCP

19
Q

Charcot’s triad: fever, RUQ pain, jaundice

Reynolds’ pentad: Charcot’s triad + hypotension + altered mental status

complication of choledocholithiasis

A

ascending cholangitis

20
Q

treatment of ascending cholangitis

A

admit to hospital –> NPO, broad spec abx, IV fluids

21
Q

chronic, persistent sx (jaundice, dark urine, acholic stools, pruritus, RUQ pain, elevated LFTs), narrowing of bile duct

can be benign or malignant

A

biliary stricture

22
Q

Benign causes of biliary stricture

A

iatrogenic, surgery, chronic pancreatitis, primary sclerosing cholangitis, autoimmune pancreatitis

23
Q

malignant causes of biliary stricture

A

pancreatic cancer, cholangiocarcinoma, gallbladder cancer, ampullary cancer

24
Q

diagnosis of biliary stricture

A

US/CT (dilated ducts, stricture), MRCP/ERCP, cholangioscopy

25
management of biliary stricture
biopsy (benign vs malignant), endoscopic dilation or stent, surgery
26
associated with IBD (UC > Crohn's), males intra and extrahepatic fibrotic strictures increased risk of cholangiocarcinoma
Primary sclerosing cholangitis
27
PSC management
liver transplant, ERCP (jaundice), monitor for cholangiocarcinoma
28
dysfunction of schincter of Oddi
females, 20-50, mimics choledocholithiasis
29
diagnosis of sphincter of Oddi dysfunction
history, elevated LFTs associated with pain, sphincter of Oddi manometry (definitive)
30
treatment of sphincter of Oddi dysfunction
endoscopic sphincterotomy
31
abd ultrasound sensitivity/specificity
95% sensitive/specific for gallstones 90% accuracy for cholecystitis 50% sensitive for choledocholithiasis