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39 Cards in this Set
- Front
- Back
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Pathogenesis of cholelithiasis
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3 types of stones:
cholesterol (from bile supersaturated with cholesterol, hypomotile gb) black pigmented stones (seen in hemolytic dz and alcoholic cirrhosis), from unconjugated bili brown stones: from biliary tract infection |
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clinical features of cholelithiasis
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most are asx
biliary colic |
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dx of cholelithiasis
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ruq u/s
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tx of cholelithiasis
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none needed unless repeated bouts of biliary colic, then tx with cholecystectomy
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complications of cholelithiasis
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cholecystitis
choledocholithiasis gallstone ileus malignancy |
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pathogenesis of acute cholecystitis
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obx of cystic duct --> inflammation of gb wall
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clincal features of acute cholecystitis
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ruq pain that may radiate to right shoulder
murphy's sign |
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dx of acute cholecystitis
what if initial study is negative? |
ruq u/s: shows pericholecystic fluid
if u/s is negative, do hida scan to look for dye not filling gb |
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tx of acute cholecystitis
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hydration, bowel rest, abx, pain meds
cholecystectomy |
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complications of acute cholecystitis
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gangrenous cholecystitis
GB perforation emphysematous cholecystitis fistula with gallstone ileus |
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pathophys of gallstone ileus
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gallstone enters bowel lumen via fistula with gb, gets stuck --> obx
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pathogenesis of choledocholithiasis
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gallstone gets stuck in cbd
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what are the two types of stones seen in choledocholithiasis
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primary: pigmented, orginate in cbd
secondary: from gb, then pass into cbd, usually cholesterol or mixed |
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clinical presentation of choledocholithiasis
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most pts are asx for years
ruq pain +/- jaundice |
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dx of choledocholithiasis
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ercp (shows cbd dilation)
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tx of choledocholitiasis
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ercp with sphincterotomy and stone extraction, stent placement
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complications of choledocholithiasis
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cholangitis
pancreatitis biliary cirrhosis |
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pathogenesis of cholangitis
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obx --> biliary stasis --> bacterial overgrowth and infection
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clinical presentation of cholangitis
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charcot's triad (fever, ruq pain, jaundice)
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dx of cholangitis
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ercp
hyperbilirubinemia elevated lfts |
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tx of cholangitis
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iv abx and ivf
once afebrile x 48 hrs, ercp |
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complications of cholangitis
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hepatic abscess
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risk factors for carcinoma of the gallbladder
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gallstone
fistulas porcelain gb |
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clinical findings of carcinoma of the gb
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palpable gb
jaundice biliary colic weight loss |
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tx of carcinoma of the gb
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surgery, but 90% die w/i first year of dx
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porcelain gb
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transmural calcification of gb, 50% risk of developing carcinoma of the gb
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pathogenesis of primary biliary cirrhosis
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destruction of the intrahelpatic bile ducts, with portal inflammation and scarring
autoimmune dz |
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clinical presentation of pbc
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middle aged women with automimmune dz
fatigue pruritis ruq pain |
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dx of pbc
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+AMA
cholestatic lfts elevated alk phos liver bx to confirm dx |
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tx for pbc
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urodeoxycholic acid slows the progression and relieves sx
liver transplant is curative |
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pathogenesis of primary sclerosing cholangitis
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thickening of bile duct walls and narrowing of their lumens
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clinical presentation of psc
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pt with uc, pruritis, and jaundice
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dx of psc
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ercp shows bead like strictures and dilations of intra and extra hepatic ducts
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tx of psc
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ercp + stent placement to relieve sx
liver transplant is curative |
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complications of psc
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cholangiocarcinoma
recurrent cholangitis portal htn liver failure |
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pathogenesis of cholangiocarcinoma
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tumor of extra or intrahepatic bile ducts
psc is a major risk factor |
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clinical presentation of cholangiocarcinoma
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60 yo with obx jaundice and weight loss
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dx of cholangiocarcinoma
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ercp
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tx of cholangiocarcinoma
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most tumors are unresectable
ercp + stent placement can relieve sx |
