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17 Cards in this Set

  • Front
  • Back
Acute Cholecystitis
Inflammation of GB wall
1/3 of gallstone patients
RUQ pain
Acute Cholecystitis is caused by:
Obstruction of the GB neck or cystic duct
1/3 gallstone pts
90-95% cholelithiasis
5% death
Primary and Secondary Signs
Primary: gallstones, Murphy's sign, impacted gallstone
Secondary: GB dilation, sludge, diffuse wall thickening
Chronic Cystitis
Symptomatic but non-acute cholecystolithiasis
Recurrent biliary colic lasting several hours
Chronic Cystitis is caused by:
A transient obstruction of the GB neck or cystic duct
Murphy's Sign
Firmly placing a hand in RUQ and asking pt to breathe deeply
An inflamed GB will cause pain and pt will need to catch their breath
Chronic Cholecystitis complications:
Emphysematous cholecystitis, gangrenous cholecystitis, perforation page, sludge
Pitfalls in imaging gallstones
Bowel gas, limey bile/milk of calcium bile, atypical gallstones, floating stones, hemobilia, side lobe artifacts
Limey Bile Syndrome (LBS)
Rare, radiopague GB and/or bile ducts
Caused by calcium carbonate Assoc. with distal biliary tract obstruction
May be caused by parenteral nutrition
Intrahepatic biliary neoplasms
Almost always cystadenoma, malignant counterpart is cystadenocarcinoma

Needle aspiration for dx
Intrahepatic biliary neoplasms most common in:
Middle aged women

Ab pain and mass, jaundice, cystic masses w/ mult. septae
Sclerosing and AIDS cholangitis
50% have ulcerative colitis
Increased ALP and bilirubin
Small cystic bile duct dilation
Smooth or irregular wall thickening if intrahepatic bile ducts
Intrahepatic biliary calculi AKA:
Recurrent pyogenic cholangitis
Oriental cholangiohepatitis
Intrahepatic Pigment stone disease
Biliary obstruction of Chinese
Intrahepatic biliary calculi
Asians-occurs in pts w/ prolonged bile stasis
Thought to be caused by biliary parasite
Soft, clay like stone
L lobe, 1st and 2nd branches intrahepatic ducts

Tx-biliary anastomosis
Carolis Disease
Adult abnormality
Congenital dilation of intrahepatic bile ducts (cystic dilation)
Carolis Disease Complications
Pyogenic Cholangitis
Hepatic abscess
Intrahepatic biliary obstruction
7% cholangiocarincoma
Carolis disease in children is assoc. w/:
Fibrosis, portal hypertension, terminal liver failure