2.2 Cs Exam 2: Diseases Of The Biliary Tract

Front 1

what is normal total bilirubin? what do you see first icterus or jaundice?

Back 1

total bilirubin= 1
see icterus first and then jaudice at around 3.

Front 2

what is the + murphy's sign?

Back 2

The catch of breath that occurs when the gallbladder makes contact with your hand.

= cholecystitis

Front 3

which test is best to identify gall stones (cholelithiasis) and should be done first?

which test should be done second?

Back 3

US= do 1st (90%)
HIDA: do 2nd

Front 4

what is the drawback associated w/ laparoscopic cholecystectomy? what do we do if we suspect cholelethiasis?

Back 4

cannot explore the common duct for stones there (choledoclethiasis)--> if suspected do an open cholecystectomy.

Front 5

how do you tx a high risk (elderly, etc) cholelithiasis pt?

*Pts in 70's have 2x risk of mortality w/ cholecystectomy, 80's have 3x

Back 5

US percutaneous aspiration of the gallbladder or ERCP w/ sphincterotomy & stone removal.

Front 6

what is the main cause of cholecsytitis? what are the 2 minor categories of causes?

Back 6

major- 90% from calculi
minor- 5% acalculus (micro crystal dz)
5% from other causes: like infection, AI, cholangitis, tumor, strictures, sphincter of oddi dysfunction

Front 7

what are two manifestations of choleolithasis?

Back 7

if above the pancreas: the stone is obstructing the liver + gallbladder = elevated ALT & AST

if above the pancreatic duct: you get liver + gallbladder + pancreatic sxs.

Front 8

what is the massive list of complications associated with cholecystitis?

Back 8

porcelin gallbladder
chronic cholecytitis
pancreatitis
hydrops (swollen gallbladder, obstruct bile duct)
emphysema (air in gallbladder d/t bacteria or perforation)
empyema
adenomatous wall changes
choledocholithiasis
gangrene
fistula formation
jaundice
sepsis
surgical morbidity
DEATH

Front 9

what is primary sclerosing cholangitis?

what chronic illness is this associated w/ 70% of the time?

what population has a decreased incidence of primary sclerosing cholangitis?

Back 9

nonmalignant, nonbacterial obstruction of the ducts d/t chronic inflammatory fibrosis & results in progressive obliteration of intrahepatic & extrahepatic bile ducts;

ulcerative colitis

dec incidence in smokers

Front 10

what are the sxs and sns of primary sclerosing polyangitis?

Back 10

asymptomatic- mostly

some: charcot's traid: abdominal pain (RUQ), fever & jaundice w/ a clear US.

intense pruritis (= bile duct obstruction!!)

some fat soluble deficiencies

Front 11

what are the diagnostic tools used for primary sclerosing polyangitis?

what will you see cholangiogram that is a big diagnostic clue for PSP?

Back 11

ERCP & elevated alkaline phosphatase and/or LFT's, elevated bilirubin (all 3 = obstruction)

cholangiogram= "beading" of the bile ducts.

Front 12

how do you tx primary sclerosing polyangitis? what tx completely cures them?

Back 12

ursodiol (stone melter)
MTX
steroids
antibiotics-- in case there is enough stasis that they dev bacterial infection secondary to this
ERCO
biliary stints

curative: liver transplant

Front 13

what are the two big risks associated w/ primary sclerosing polyangitis?

Back 13

higher risk of cholangiocarcinoma (10%) and inc risk of esophageal varices.