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29 Cards in this Set
- Front
- Back
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Gall stones:
90% are ____ |
cholesterol or mixed stones
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Black-pigmented stones occur with ____
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cirrhosis or chronic hemolysis
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Brown-pigmented stones occur with ____
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biliary tract infection
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Gallstones more common in ____
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women 2:1
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all predispose to gallstones
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Obesity, number of pregnancies, rapid weight loss, TPN, conjugated estrogens and OCP’s, Crohn’s disease, and diabetes mellitus
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Increased bile lithogenicity and _______ gall bladder motility assoc with gallstones
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decreased
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60-80% of gall stones are asymptomatic at a given time
Once stones begin to cause symptoms, the risk of continuing problems is ____ |
high
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More than 90% of complications, such as cholecystitis, cholangitis, or pancreatitis, are preceded by attacks of biliary ____
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colic
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Pain of biliary colic may radiate where?
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Pain may radiate to right scapula
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Acute Cholecystitis
90% of cases caused by ____ duct obstruction by gallstones |
cystic
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(+) Murphy’s sign-abrupt arrest in _______ during direct palpation of the RUQ
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inspiration
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Stones in the Common Bile Duct (CBD)
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Choledocholithiasis
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What are the effects of a clogged common bile duct?
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Jaundice and pruritis may occur
Cholangitis (bacterial infection of the bile) is a common complication Acute pancreatitis may be caused by stones or sludge in the CBD |
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Ultrasonography has high specificity and sensitivity for stones. Thickening of the gall bladder wall and pericholecystic fluid can also be seen. Ultrasound can also reveal dilated bile ducts.
What kind of stones often not seen with U/S |
CBD
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Hepatobiliary Scintigraphy
High sensitivity and specificity for _____ cholecystitis |
acute
Less helpful for chronic cholecystitis or gall bladder dysfunction |
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What's CT good for? in the hepato-pancreato-biliary world
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Not as good as ultrasound for stones in gall bladder or CBD
Excellent for pancreas, especially when done with IV contrast Useful to see dilated bile ducts within and outside the liver |
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What's MRCP good for? in the hepato-pancreato-biliary world
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Biliary and pancreatic ducts can be visualized
Excellent for CBD stones Diagnostic only Pacemakers, vascular clips, prosthetic heart valves all contraindications to MRI/MRCP No risk of pancreatitis or cholangitis |
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What's Endoscopic Retrograde Cholangiopancreatography (ERCP) good for? in the hepato-pancreato-biliary world
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Directly visualize the biliary tree or pancreatic duct
Stones can be removed Strictures can be brushed for cytology, dilated, or stented w/ plastic or metal stents Risks of bleeding (small risk), perforation (small), pancreatitis (5-10%) |
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What's Laparoscopic Cholecystectomy good for? in the hepato-pancreato-biliary world
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State-of-the-art surgical procedure for symptomatic gallstones
Prophylactic cholecystectomy only recommended for calcified (porcelain) gall bladder because of increased risk of gall bladder cancer Complication rates similar to open chole |
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Choledocholithiasis
Many surgeons not able to clear the CBD of stones using a laparoscopic approach-either have to convert to an open procedure or obtain a postop ____ Stones should not be left in the CBD, as cholangitis or pancreatitis may result |
ERCP
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Non-stone cause of the following:
Abdominal pain, jaundice, and recurrent cholangitis may occur Risk of cholangiocarcinoma is increased Therapy is surgical |
Biliary Cysts
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What's the following disease?
Inflammation and fibrosis of the bile duct Obliteration of bile ducts leads to biliary cirrhosis, portal hypertension, and liver failure Occurs in men, often with a history of inflammatory bowel disease No serum marker available |
Primary Sclerosing Cholangitis
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Treatment of Primary Sclerosing Cholangitis
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No medical therapy available
Dominant strictures may be stented |
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_________ occurs in 5-30% of PSC cases
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Cholangiocarcinoma
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Life extending therapy for primary sclerosing cholangitis
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OLT is the only life-extending therapy, but results are dismal once cancer develops
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Courvoisier’s sign
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sign of malignancy - bulging gall bladder probably from blocked duct
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Ampullary cancer signs?
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Silver stools
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Indians with Gall bladder cancer
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Pima Indians
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What dysfunction?
Acalculous disorder associated with biliary-type pain, cholestasis, and pancreatitis Female gender Recurrent abdominal pain after chole Manometry at ERCP makes the diagnosis Sphincterotomy may be curative |
Sphincter of Oddi Dysfunction
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