UW revision cholangitis + primary biliary 03-05 (2)

Question 1

Acute cholangitis. Etiology? 3 types according to mehlman.

Answer 1

UW: ascending infection due to biliary obstruction

(M) 2/5 Q – ascending cholangitis due to bowel flora (E. coli, bacterioides)
(M) 2/5 Q – primary sclerosing cholangitis in the setting of IBD
(M) 1/5 Q – history of cholelithiasis  now cholangitis

Question 2

Acute cholangitis. CP? triad

Answer 2

Charcot triad: fever, RUQ pain (usmle says abdominal pain), jaundice (in 50-75 proc.)

Question 3

Acute cholangitis. CP? pentad

Answer 3

Reynolds: altered mental status, hypotension

Question 4

Acute cholangitis. Dx? labs

Answer 4

Incr. Direcr bilirubin and ALP
Incr. inflammatory
Mild. incr. in aminotransferases

is sepsis: anion gap metabolic acidosis

Question 5

Acute cholangitis. Dx? instumental

Answer 5

MODALITY OF CHOICE = UG

also can do CT scan.

Question 6

Acute cholangitis. Tx?

Answer 6

Broad abs + iv fluids + ERCP (within 24-48h)

or other optionp: percutaneous drainage (percutaneous transhepatic cholangiography with drain placement)

Question 7

(M) Acute cholangitis. USMLE wants what Dx and Tx?

Answer 7

Abs + ERCP

Biliary drainage by ERCP decr. morbidity and mortality

ERCP with sphincterotomy

Question 8

Acute cholangitis. Elevated intrabiliary pressure allowrs for disruption of the bile-blood barrier and translocation og bacteria from the hepatobiliary system into bloodtream.

Question 9

Acute cholangitis. What is seen on UG or CT?

Answer 9

DILATION OF INTRAHEPATIC AND COMMON BILE DUCT.

Question 10

Primary biliary cholangitis. pathogenesis?

Answer 10

autoimmune intrahepatic bile duct destruction

Question 11

Primary biliary cholangitis. what age?

Answer 11

30-60 females

Question 12

Primary biliary cholangitis. CP? also what hepatic?

Answer 12

Fatigue and pruritus —> jaudice, hepatomegaly, cirrhosis

Question 13

Primary biliary cholangitis. extrahepatic CP?

Answer 13

xanthomas and xanthelasmas

due to high cholesterol. Also incr. risk for atherosclerosis

Question 14

Primary biliary cholangitis. lab. liver?

Answer 14

cholestatic liver injury = incr. bilitubin, ALP

Less prominent incr. in AST and ALT

Question 15

Primary biliary cholangitis. lab. blood?

Answer 15

severe hypercholesterolemia (todel ir xanthomos)

Question 16

Primary biliary cholangitis. lab. titer?

Answer 16

antimitochondrial antibody (AMA)

Question 17

Primary biliary cholangitis. Tx? delays progression

Answer 17

Ursodeoxycholic acid

Question 18

Primary biliary cholangitis. Tx in advanced disease?

Answer 18

Liver transplant

Question 19

Primary biliary cholangitis. complications. Vitamins?

Answer 19

ADEK deficiency

Question 20

Primary biliary cholangitis. complications. Bones?

Answer 20

metabolic bone disease (osteoporosis, osteomalacia, osteopenia)

Question 21

Primary biliary cholangitis. complications. liver?

Answer 21

hepatocellular carcinoma

Question 22

Primary biliary cholangitis. complications. Bones Cause: toxic accumulation of substances that inhibits bone remodeling + malabsorbtion of vit. D.

Answer 22

.

Question 23

Primary biliary cholangitis. NOT RELATED OT UC!!!!!!!!!!!

Primary sclerosing is related to UC!!!!!

Answer 23

.

Question 24

Primary biliary cholangitis. Sequelae of cirrhosis. also steatorrhea

Answer 24

.

Question 25

Primary biliary cholangitis. Symptoms + labs. You do abdominal UG. What is seen?

Answer 25

UG distinguishes INTRAHEPATIC ( no biliary tract dilation) from EXTRAHEPATIC (biliary tract dilation eg due to gallstones) cholestasis

If case says: normal bile ducts on UG = it means cholestasis is intrahepatic.

Question 26

Primary biliary cholangitis. Symptoms + labs. You do abdominal UG –> normal bile ducts on UG –> next step?

Answer 26

do serum anti-mitochondrial antibody titers.

Question 27

Cholestasis on labs. + do abdominal ug. IF extrahepatic cause suspected next step?

Answer 27

If suspected extrahepatic –> NEXT STEP –> MR cholangiography [high sensitivity for biliary tree disorders] or CT scan [for pancreatic carcinoma]

ERCP for choledocholithiasis

Question 28

Cholestasis on labs. + do abdominal ug. IF intrahepatic cause suspected next step?

Answer 28

If intrahepatic suspected –> NEXT STEP –> screen for autoimmune or systemic disease (eg antimitochondrial antibodies for PBC)

Question 29

Yra algoritmai cholestazes, juos reik papaisyt. ner kortu ir R+

Answer 29

.

Question 30

Ug in sarcoidosis = intrahepatic cholestasis.

Same as in PBC.

Tipo intrahepatic = causes include autoimmune of infiltrative disorders (PBC, sarcoidosis)

Answer 30

.