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Clin med A 2 > Trigger - Gallbladder > Flashcards

Trigger - Gallbladder Flashcards

1
Q

normal exam and labs. RUQ pain radiating to back

A

cholelithiasis

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2
Q

treated with NSAIDS or lap chole

A

cholelithiasis

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3
Q

what is the difference when treating a native american patient w cholelithiasis

A

lap chole instead of NSAIDS just becauase they are more prone to stones

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4
Q

what can be used in lap chole’s to avoid injury to the common bile duct

A

intraoperative cholangiogram

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5
Q

treat with ursodeoxycholic acid

A
  • non surgical candidates with symptomatic cholelithiases
  • Primary sclerosing cholangitis patients (in addition to cipro, ERCP, stenting, transplant, ect.)
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6
Q

MC in Men 20-50

A

primary sclerosing cholangitis

also MC in IBD (UC or CD)

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7
Q

MC in pts with UC or CD

A

Primary sclerosing cholangitis

also MC in men 20-50

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8
Q

MC in critically ill pts or post op pts after major surgery

A

acute acalculous cholecystitis

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9
Q

RUQ pain with fever, tachycardia and NV

A

cholecystitis

also see:
+ murphys sign
luekocytosis
normal LFT

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10
Q

+ murphys sign
leukocytosis
normal LFTs

A

acute cholecystitis

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11
Q

US showing stone lodged at cystic duct and gallbladder thickening > 4mm

A

acute cholecystitis

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12
Q

HIDA scan shows obstructed cystic duct and nonvisualized gallbladder. also shows GB EF of 12%

A

acute cholecystitis

remembe EF<35% = lap chole needed

primary imaging is US tho

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13
Q

who is HIDA CI in

A

pregggooooooooo

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14
Q

what is the name for a stone in the neck of the gallbladder causing jaundice post acute cholecystitis

A

mirizzi syndrome

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15
Q

what is the term for when acute cholecystitis subsides but the cystic duct is still blocked

A

Hydrops of gallbladder

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16
Q

what is the tx for acute cholecystitis

A

Pip/taz
OR
Mid gen ceph + metro
OR
Cipro + metro

also NPO and NG tube
also IV meperidine or NSAIDS
also lap chole in 1-2 days

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17
Q

In a high risk patient (elderly or DM) what tx is used instead of lap chole

A

percutaneous cholecystectomy

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18
Q

RUQ pain, jaundice, NV, epigastric tenderness

A

choledocholithiasis

19
Q

high AST/ALT
hyperbilirubinemia

later on high ALP and GGT

A

choledocholithiasis

20
Q

RUQ pain with elevated LFTs

A

choledocholithiasis

21
Q

Transabdominal U/S showing CBD dilation

A

choledolithiasis

22
Q

ERCP with sphincterotomy and stent + cholecystectomy

A

choledocholithiasis treatment

23
Q

confirmation of diagnosis with MRCP or endoscopic US

A

choledolithiasis

24
Q

what must be present for ERCP

A

a stone.

25
Q

RUQ pain, Fever, Jaundice, Hypotension, AMS

A

acute cholangitis

26
Q

leukocytosis, elevated CRP, bilirubin and PTT

A

cholangitis

also may see elevated AST/ALT and ALP

27
Q

diagnostic criteria for acute cholangitis

A
  1. systemic inflammation (fever or high CRP)
  2. bilirubin of >2 or LFTs>1.5 UNL
  3. imaging showing dilation or presence of stone/stricture/stent
28
Q

treatment for acute cholangitis

A

Admit ASAP
ERCP within 48 hours
Lap Chole after ERCP
Mild-mod: Cipro + metro
Severe (organ damage): Zosyn + Metro

29
Q

immune response to endotoxins

A

primary sclerosing cholangitis

30
Q

presents with 6 phases.

name the six phases and the disease

A

primary sclerosing cholangitis

Asymptomatic
Obstructive jaundice
Progressive jaundice
Pruritis
Fatigue, anorexia, indigestion
Hepatosplenomegaly

31
Q

elevated AST/ALT, ALP and hypergammaglobulinemia.

also elevated IgM and P-ANCA

A

prijmary sclerosing cholangitis

32
Q

MRCP shows beads on a string

A

primary sclerosing cholangitis

(imaging of choice)

33
Q

liver biopsy showing onion skin

A

primary sclerosing cholangitis (last resort imaging)

34
Q

Cipro for acute episodes
Ursodeoxycholic acid under testing

Symptomatic treatment only and management only

A

primary sclerosing cholangitis

35
Q

Incurable disease with prognosis of 9-17 yrs :(

A

primary sclerosing cholangitis

36
Q

Chronic infection with salmonella typhi

A

gallbladder carcinoma

also presents with polyps and calcification

37
Q

MC in ages 50-70

A

cholangiocarcinoma

38
Q

Confluence of the hepatic ducts is MC spot

A

cholangiocarcinoma

39
Q

more common in primary sclerosing cholangitis and biliary cirrhosis

A

cholangiocarcinoma

also Immunocomp

40
Q

Distended, palpable gallbladder is called what? when is this seen

A

courvoisier sign

seen in carcinomas of biliary tract`

41
Q

RUQ tenderness, Hepatomegaly, Courvoisier sign, Ascites

A

carcinoma of biliary tract

42
Q

CA 19-9 on labs

A

carcinoma of biliary tract

also elevated LFTs and hyperbilirubinemia

43
Q

tx is Roux-en-y-hepaticojejunostomy

A

non-resectable carcinoma of biliary tract

Clin med A 2 (30 decks)

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