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55 Cards in this Set
- Front
- Back
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1. What is cholecystitis?
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a. Inflammation of the gallbladder
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2. What is cholelithiasis?
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a. Presence of stones in the gallbladder
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3. What is cholangitis?
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a. Inflammation of the biliary tree
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4. What is choledocholithiasis?
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a. Presence of a stone or stones in the common bile duct
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5. What is biliary colic?
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a. RUQ pain caused by contraction of the gallbladder against an obstructed outlet
b. Can radiate to back/scapular region |
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6. How long does biliary colic usually last?
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a. 1-4 hours
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7. What are the associated symptoms of biliary colic?
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a. Nausea
b. Vomiting c. Tachycardia d. <1 week |
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1. What is biliary dyskinesia?
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a. Biliary colic caused by gallbladder dysfunction, not obstruction
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9. What is Cantlie’s line?
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a. Divides liver into 2 halves
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10. What is Boas’ sign?
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a. Right subscapular referred pain due to cholecystitis
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11. What is the vein of Mayo?
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a. Prepyloric vein
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12. What is Hartmann’s pouch?
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a. Pre-fundal outpouching of the gallbladder
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13. What are the borders of the triangle of Calot?
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a. Cystic duct
b. Cystic artery c. Common hepatic duct |
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14. From what embryological layer does the gallbladder originate?
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a. Foregut
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15. What causes the gallbladder to contract?
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a. CCK
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16. What is the function of bile?
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a. Helps emulsify fats through saponification
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17. What makes up bile?
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a. Water-- 90%
b. Cholesterol, bile salts, phospholipids-- 90% of the rest |
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18. What are risk factors for gallstones?
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a. Obesity
b. High estrogen and progesterone c. Increases with age d. Race (Native Americans and Caucasians) e. Female |
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19. What is the rule for complexion and risk for gallstones?
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a. “The whiter you are, the higher your risk is.”
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20. What is the rule of F’s for gallstone risk?
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a. Fat
b. Fertile c. Forty d. Female e. Fair-complected f. Flatulant |
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21. What are some secondary risk factors for gallstones?
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a. Oral contraceptives
b. Hemolytic disease c. TPN d. Hyperlipidemia e. Vagotomy |
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22. What makes up non-pigmented gallstones?
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a. Cholesterol
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23. What makes up pigmented gallstones?
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a. Black=hemolysis-- calcium bilirubinate
b. Brown=infection |
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1. What is jaundice? What level of bilirubin usually manifests as jaundice?
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a. Bronzing of the skin caused by increased serum levels of bilirubin
b. >2.5 |
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25. How is hemoglobin metabolized?
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a. Hem metabolized to bilirubin in spleen and carried to liver (bound to albumin)
b. Taken up by liver and conjugated to glucuronic acid c. Excreted as bile into duodenum d. Broken down by intestinal bacteria to urobilinogen |
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26. What causes prehepatic jaundice?
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a. Hemolytic diseases
b. Increased production of bilirubin exceeds the liver’s capacity of conjugation |
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27. What is increased in prehepatic jaundice?
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a. Unconjugated bilirubin
b. Urine urobilinogen |
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28. What causes hepatic jaundice?
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a. Hepatocellular damage reduces the liver’s ability to conjugate bilirubin and reduces its efficiency of secreting conjugated bilirubin into bile
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29. What increases in hepatic jaundice?
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a. Total bilirubin
b. Urine urobilinogen c. AST d. ALT |
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30. What causes post-hepatic jaundice?
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a. Biel duct obstruction prevents bile from entering the duodenum reducing fat absorption
b. Liver regurgitates conjugate bilirubin into the blood |
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31. What increases in post-hepatic jaundice?
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a. Conjugated bilirubin
b. ALP c. GGT d. AST/ALT (maybe) e. INR |
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32. What are the side effects of post-hepatic jaundice?
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a. Tea-colored urine
b. Pale, clay-colored stools |
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33. What causes pruritus associated with liver disease?
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a. Increased bile acids
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1. What is Courvoisier’s law?
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a. A non-tender, palpable gallbladder with jaundice suggests malignancy of the pancreatic head
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35. What are the symptoms of cystic duct obstruction?
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a. Enlarge gallbladder
b. No jaundice |
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36. What are the symptoms of common bile duct obstruction?
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a. Non-palpable gallbladder
b. Jaundice c. PAIN |
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37. What are the symptoms of a malignancy in the head of the pancreas?
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a. Enlarged gallbladder
b. Jaundice |
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1. What is the 1° imaging modality for gallstones?
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Ultrasound
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40. What is the normal gallbladder luminal diameter?
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a. 4mm + 1mm/decade over 40
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41. What causes acute cholecystitis?
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a. Sustained obstruction causes progressive distension and inflammation which may spread to involve parietal peritoneum
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42. What differentiates biliary colic from pain in acute cholecystitis?
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a. Acute cholecystitis is more sustained and constant
b. May last days c. Can present with low-grade fever and elevated WBCs |
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43. How do you tx acute cholecystitis?
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a. NPO
b. IV fluids c. Antibiotics d. NG tube |
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39. What is the normal gallbladder wall thickness?
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a. <3mm
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44. When should a cholecystectomy be performed in acute cholecystitis?
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a. If within 72 hours of symptom onset
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45. When should a cholecystostomy be performed in acute cholecystitis?
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a. If > 72 hours since symptom onset
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46. What is acalculous cholecystitis?
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a. Inflammation of GB in absence of demonstrated calculi
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47. What is biliary sludge?
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a. Microscopic to sand-sized crystals
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48. How do you detect acalculous cholecystitis?
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a. HIDA scan
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49. What is done in a HIDA scan?
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a. A radionucleotide is injected IV and taken up by liver which concentrates it in bile
b. Visualization of CBD and duodenum after 4 hours without filling of gallbladder indicates obstruction |
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50. What can be given to determine gallbladder ejection fraction? What % is diagnostic for biliary dyskinesia?
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a. CCK
b. <35% |
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51. What are the symptoms/complications of acute cholangitis?
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a. Pancreatitis
b. Septicemia/shock c. Death |
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52. What usually causes acute cholangitis?
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a. Gallstone pushed down into common bile duct
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53. What is Charcot’s triad? With what is it associated?
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a. Fever, jaundice, RUQ pain
b. Suppurative cholangitis |
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54. What is Reynold’s pentad? With what is it associated?
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a. Fever, jaundice, RUQ pain, hypotension, mental status changes
b. Worsening suppurative cholangitis/sepsis |
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55. What can you do through an ERCP?
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a. Stone removal
b. Emergent decompression c. Stent placement d. Sphincerotomy e. Diagnostics |
