Kgi 150-200

Front 1

Q150. Sign: the arrest of inspiration while palpating the RUQ. what is the Dx if positive?

Back 1

A150. Murphy's sign; Dx: Acute cholecystitis

Front 2

Q151. Dx test of choice for cholecystitis

Back 2

A151. 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 3

Q152. What condition is an ERCP most accurate for?

Back 3

A152. Primary Sclerosing Cholangitis

Front 4

Q153. Tx for cholecystitis in order; (2 meds; 1 procedure)

Back 4

A153. Pain control;; 2nd or 3rd generation Cephalosporin;; Cholecyctectomy

Front 5

Q154. 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 5

A154. Ascending cholangitis

Front 6

Q155. Definition: stone obstruction of the common bile duct

Back 6

A155. Choledocholelithiasis

Front 7

Q156. Charot's triad of Ascending Cholangitis; Reynolds pentad?

Back 7

A156. Charot's triad:; RUQ pain;; Jaundice;; Fever Reynold's pentad: above plus; Shock (hypotension);; Altered mental status

Front 8

Q157. *Tx of choice for Ascending cholangitis

Back 8

A157. ERCP with endoscopic sphinctorotomy

Front 9

Q158. Definition: Chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic biliary tree. What is it associated with?

Back 9

A158. Primary sclerosing Cholangitis; Associated with: Ulcerative Colitis

Front 10

Q159. Dx: 34-yo man with a history of ulcerative colitis presents with jaundice and elevated GGT and alk-phos.

Back 10

A159. Primary Sclerosing Cholangitis

Front 11

Q160. ERCP showing "beads on a string" appearance

Back 11

A160. Primary Sclerosing Cholangitis

Front 12

Q161. Pathogenesis of cholelithiasis

Back 12

A161. 3 types of stones:; cholesterol (from bile supersaturated with cholesterol, hypomotile gallbladder); black pigmented stones (seen in hemolytic disease and alcoholic cirrhosis), from unconjugated bili; brown stones: from biliary tract infection

Front 13

Q162. clinical features of cholelithiasis

Back 13

A162. most are asymptomatic; biliary colic

Front 14

Q163. dx of cholelithiasis

Back 14

A163. RUQ u/s

Front 15

Q164. tx of cholelithiasis

Back 15

A164. none needed unless repeated bouts of biliary colic, then tx with cholecystectomy

Front 16

Q165. complications of cholelithiasis

Back 16

A165. cholecystitis; choledocholithiasis; gallstone ileus; malignancy

Front 17

Q166. pathogenesis of acute cholecystitis

Back 17

A166. obstruction of cystic duct --> inflammation of gallbladder wall

Front 18

Q167. clincal features of acute cholecystitis

Back 18

A167. RUQ pain that may radiate to right shoulder; murphy's sign

Front 19

Q168. dx of acute cholecystitis; what if initial study is negative?

Back 19

A168. RUQ u/s: shows pericholecystic fluid; if u/s is negative, do HIDA scan to look for dye not filling gallbladder

Front 20

Q169. tx of acute cholecystitis

Back 20

A169. hydration, bowel rest, antibiotics, pain meds; cholecystectomy

Front 21

Q170. complications of acute cholecystitis

Back 21

A170. gangrenous cholecystitis; GALLBLADDER perforation; emphysematous cholecystitis; fistula with gallstone ileus

Front 22

Q171. pathophysiology of gallstone ileus

Back 22

A171. gallstone enters bowel lumen via fistula with gallbladder, gets stuck --> obstruction

Front 23

Q172. pathogenesis of choledocholithiasis

Back 23

A172. gallstone gets stuck in common biliary duct

Front 24

Q173. what are the two types of stones seen in choledocholithiasis

Back 24

A173. primary: pigmented, originate in common biliary duct; secondary: from gallbladder, then pass into common biliary duct, usually cholesterol or mixed

Front 25

Q174. clinical presentation of choledocholithiasis

Back 25

A174. most patients are asymptomatic for years; RUQ pain +/- jaundice

Front 26

Q175. dx of choledocholithiasis

Back 26

A175. ERCP (shows common biliary duct dilation)

Front 27

Q176. tx of choledocholitiasis

Back 27

A176. ERCP with sphincterotomy and stone extraction, stent placement

Front 28

Q177. complications of choledocholithiasis

Back 28

A177. cholangitis; pancreatitis; biliary cirrhosis

Front 29

Q178. pathogenesis of cholangitis

Back 29

A178. obstruction --> biliary stasis --> bacterial overgrowth and infection

Front 30

Q179. clinical presentation of cholangitis

Back 30

A179. charcot's triad (fever, RUQ pain, jaundice)

Front 31

Q180. dx of cholangitis

Back 31

A180. ERCP; hyperbilirubinemia; elevated lfts

Front 32

Q181. tx of cholangitis

Back 32

A181. iv antibiotics and IVF; once afebrile x 48 hrs, ERCP

Front 33

Q182. complications of cholangitis

Back 33

A182. hepatic abscess

Front 34

Q183. risk factors for carcinoma of the gallbladder

Back 34

A183. gallstone; fistulas; porcelain gallbladder

Front 35

Q184. clinical findings of carcinoma of the gallbladder

Back 35

A184. palpable gallbladder; jaundice; biliary colic; weight loss

Front 36

Q185. tx of carcinoma of the gallbladder

Back 36

A185. surgery, but 90% die within first year of dx

Front 37

Q186. porcelain gallbladder

Back 37

A186. transmural calcification of gallbladder, 50% risk of developing carcinoma of the gallbladder

Front 38

Q187. pathogenesis of primary biliary cirrhosis

Back 38

A187. destruction of the intrahepatic bile ducts, with portal inflammation and scarring; autoimmune disease

Front 39

Q188. clinical presentation of primary biliary cirrhosis

Back 39

A188. middle aged women with autoimmune disease; fatigue; pruritis; RUQ pain

Front 40

Q189. dx of primary biliary cirrhosis

Back 40

A189. Positive AMA; cholestatic liver function tests; elevated alkaline phosphatase; liver biopsy to confirm dx

Front 41

Q190. tx for primary biliary cirrhosis

Back 41

A190. urodeoxycholic acid slows the progression and relieves symptom; liver transplant is curative

Front 42

Q191. pathogenesis of primary sclerosing cholangitis

Back 42

A191. thickening of bile duct walls and narrowing of their lumens

Front 43

Q192. clinical presentation of primary sclerosing cholangitis

Back 43

A192. patient with ulcerative colitis, pruritis, and jaundice

Front 44

Q193. dx of primary sclerosing cholangitis

Back 44

A193. ERCP shows bead like strictures and dilations of intra and extra hepatic ducts

Front 45

Q194. tx of primary sclerosing cholangitis

Back 45

A194. ERCP + stent placement to relieve symptom; liver transplant is curative

Front 46

Q195. complications of primary sclerosing cholangitis

Back 46

A195. cholangiocarcinoma; recurrent cholangitis; portal HTN; liver failure

Front 47

Q196. pathogenesis of cholangiocarcinoma

Back 47

A196. tumor of extra or intrahepatic bile ducts; primary sclerosing cholangitis is a major risk factor

Front 48

Q197. clinical presentation of cholangiocarcinoma

Back 48

A197. 60 yo with obstruction jaundice and weight loss

Front 49

Q198. dx of cholangiocarcinoma

Back 49

A198. ERCP

Front 50

Q199. tx of cholangiocarcinoma

Back 50

A199. most tumors are unresectable; ERCP + stent placement can relieve symptoms

Front 51

Q200. complications of cirrhosis

Back 51

A200. portal HTN; hepatocellular failure