Im Gi Biliary Tree Usmle 2

Front 1

What stimulates the gallbladder contraction (specifically)

Back 1

Fat and Amino Acids in the proximal duodenum causes release of CCK

Front 2

Dx:
Middle-aged female patient presenting w/ pruritis and an elevated Alk Phos w/ a normal Bilirubin.

What is the best initial test?

what is the most accurate test?

Back 2

Dx:
Primary Biliary Cirrhosis

initial test:
Anti-mitochondrial Ab test

most accurate:
Liver Bx

Front 3

Risk factors for cholelithiasis
(8 F's)

Two others?

Back 3

Female;
Fat;
Forty;
Fertile;
Fibrosis (Cystic);
Familial;
Fasting;
F-Hgb (Sickle cell)

Also: DM and Oral contraceptives

Front 4

Dx:
RUQ pain that lasts 2-6 hours, most often after fatty meal, N/V, RUQ tenderness w/o guarding or rebound

Back 4

Cholelithiasis

Front 5

What labs are elevated w/ gallstones?

Back 5

Alkaline phoshatase

Bilirubin
(direct more then indirect)

Front 6

when should HIDA scan be answered?
(2)

Back 6

1. Gallstones and US Murphy's sign w/o Gallbladder edema

2. Gallbladder edema and US Murphy's sign w/o Gallstones

(if Dx is obvious, then do not answer HIDA scan)

Front 7

First Dx test of choice for gallstones?

Back 7

Ultrasound

Front 8

Out of the (3) types of gallstones, name them in least common to most.

Back 8

1. Cholesterol (10%)

2. Pigment (20%)

3. mixed (70%)

Front 9

When are Radiolucent cholesterol gallstones seen?
(3)

Back 9

rapid weight loss;

Oral contraception;

Ileal disease

Front 10

When are radiodense pigment gallstones seen?

Back 10

Hemolysis

Front 11

Treatment of gallstones in order
(1 med; 2 procedures)

Back 11

1. Chenodeoxycholate

2. Lithotripsy

3. Cholesystectomy

Front 12

Dx:
Patient has high fever, chills, RUQ abdominal pain and jaundice. She has a history of UC and is complaining of pruritus with a negative hepatitis profile and a negative US.

Next step?

Back 12

Dx: Primary Sclerosing Cholangitis

next step: ECRP

Front 13

(4) bugs that can cause cholecystitis

Back 13

BEEK:
Bacteriodes
E.coli
Enterococcus
Klebsiella

Hint 13

BEEK

Front 14

Dx:
RUQ pain often longer then 6 hours, possible guarding and rebound, fever, tachycardia, + Murphy's sign

Back 14

Cholecystitis

Front 15

Sign:
the arrest of inspiration while palpating the RUQ.

what is the Dx if positive?

Back 15

Murphy's sign

Dx: Acute cholecystitis

Front 16

Dx test of choice for cholecystitis

Back 16

HIDA:

labeled iminodiacetic acid is injected IV and taken up by hepatocytes. Normal gallbladder is outlined in 1 hour, absence of visable gallbladder = cholecystitis

Front 17

What condition is an ERCP most accurate for?

Back 17

Primary Sclerosing Cholangitis

Front 18

Tx for cholecystitis in order
(2 meds; 1 procedure)

Back 18

Pain control;

2nd or 3rd generation Cephalosporin;

Cholecyctectomy

Front 19

Definition:
complete obstruction of the biliary outflow tract due to a stone obstructing the common bile duct, a stricture or tumor. The patient becomes septic and it is life threatening

Back 19

Ascending cholangitis

Front 20

Definition:
stone obstruction of the common bile duct

Back 20

Choledocholelithiasis

Front 21

Charot's triad of Ascending Cholangitis

Reynolds pentad?

Back 21

Charot's triad:
RUQ pain;
Jaundice;
Fever

Reynold's pentad:
Shock (hypotension);
Altered mental status

Front 22

*Tx of choice for Ascending cholangitis

Back 22

ERCP w/ endoscopic sphinctorotomy

Front 23

Definition:
Chronic progressive disorder of unknown eitology characterized by inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic biliary tree.
What is it associated with?

Back 23

Primary sclerosing Cholangitis


Assoc w/: Ulcerative Colitis

Front 24

Dx:
34-yo man w/ a hx of ulcerative colitis presents w/ jaundice and elevated GGT and alk-phos.

Back 24

Primary Sclerosing Cholangitis

Front 25

ERCP showing "beads on a string" appearance

Back 25

Primary Sclerosing Cholangitis