Session 3 Cm- Gi-7- Biliary Disease

Front 1

What is cholelithiasis

Back 1

presence of stones in the gall bladder

Front 2

Who is most likely to suffer from cholelithiasis

Back 2

female, pregnancy, pt > 40yrs, or w/ family history

Front 3

What factors can predispose you to developing cholelithiasis

Back 3

obesity, oral contraceptives, diabetes, rapid weight loss, estrogen replacement tx, ileal disease, decreased physical activity

Front 4

What ethnicities are more prone to suffer from cholelithiasis

Back 4

Hispanics, northern European and pima Indians, less common in African Americans except with sickle cell disease

Front 5

If you have a pt on total parenteral nutrition what complication are they more prone to develop

Back 5

cholelithiasis

Front 6

What test can you order to dx cholelithiasis

Back 6

oral cholecystography and Gallbladder ultrasound

Front 7

This visualization technique is used to examine biliary tree (gallbladder, bile and pancreatic ducts) by combining x-ray and endoscopy useful for id of strictures and biopsy of lesions and gallstones

Back 7

Endoscopic Retrograde cholangiopancreatography ERCP

Front 8

What visualization technique of the gallbladder uses radioisotopes

Back 8

Cholescintigraphy- HIDA scan hydroxy iminodiacetic acid scan

Front 9

What does a HIDA scan show

Back 9

shows gallbladder activity not especially useful for seeing stones though

Front 10

what is cholecystogram

Back 10

x-ray used to evaluate gallbladder

Front 11

Who is more effected by cholecystitis

Back 11

Men are more affected than women though women get gallstones more than men

Front 12

What are the s/sx of cholelithiasis

Back 12

80% asymptomatic, upper right quadrant pain of constant boring quality, can also have referred pain to scapular or supracervical region. Onset starts within hours of eating

Front 13

What will you see on physical exam of pt with cholelithiasis

Back 13

normal unless having biliary colic then +murphy sign, severe intermittent cramping pain RUQ, occurs mostly at night, lasts from a few minutes to hours

Front 14

What is the tx if pt develops acute cholecystitis

Back 14

IV fluids, antibiotics, and analgesics then cholecystectomy should be done within 72hrs

Front 15

When wouldn't you want to perform a cholecystectomy with acute cholecystitis

Back 15

pt has diffuse peritonitis, acute gallbladder perforation, systemic sepsis, diabetes, patient develops acalculous acute cholecystitis in ICU, or emphysematous cholecystitis

Front 16

When would you do an open cholecystectomy over laparoscopy

Back 16

if gallbladder is extremely inflamed, infected or has large gallstones

Front 17

your pt can't be put under general anesthesia and is having acute cholecystitis what can be done for them

Back 17

put in a percutaneous cholecystostomy tube under local anesthesia. Tube can be removed in 6 weeks if it is acalculous

Front 18

What are gallstones made of

Back 18

cholesterol, bilirubin, calcium, other organic material only 10% are pure cholesterol

Front 19

What will you see on labs if pt has cholelithiasis

Back 19

normal labs unless obstruction then you get increased alk phos an bilirubin

Front 20

When would you prefer to use MRCP (magnetic resonance cholangiopancreatography) over ERCP (endoscopic retrograde cholangiopancreatography)

Back 20

Pediatric or Elderly pt, pt with co morbidity, acute pancreatitis, cholangitis. But it may miss low grade strictures and you can get false positives

Front 21

What are some complications that can arise w/ cholecystitis

Back 21

infection of gallbladder, mirizzi's syndrome (impacted gallbladder stone in cystic duct or neck of g.b.), cholecystoenteric fistula (erosion of stone through g.b wall, acute cholangitis

Front 22

What treatment can be given to get rid of gall stones without removing gallbladder

Back 22

direct solvent dissolution (methyl tertiary butyl ether), extracorporeal shock wabe lithotripsy (used on big stones >3cm), oral bile salts (ursodiol/chenodial for poor surgical candidates)

Front 23

This is inflammation of Gallbladder w/o detectable stones and s/sx of biliary colic. Pt presents w/ fever and elevated amylase occurs with trauma, burn patients or immunosuppressed

Back 23

Acalculous Cholecystitis

Front 24

Who are at increased risk for developing acalculous cholecystitis

Back 24

burn patients on ventilators, immunosuppressed, trauma pt on ventilators

Front 25

Why is acalculous cholecystitis concerning

Back 25

high mortality rate of 10-50% can be dx with HIDA scan that show gallbladder dyskinesia,

Front 26

What is the most common cause of acute pancreatitis world wide

Back 26

choledocholithiasis- bile duct stones that have migrated from gallbladder to common bile duct

Front 27

What is recommended tx for choledocholithiasis

Back 27

stone passes spontaneously in mild cases but cholecystectomy is recommended

Front 28

This is associated with biliary obstruction and then infection of biliary tree 6-9% of pts with gallstones develop this

Back 28

acute cholangitis

Front 29

What is Charcot's triad of cholangitis

Back 29

pain, fever, jaundice

Front 30

What is Reynolds pentad a combination of Charcot's triad w/ two more concerning signs indicating an emergency cholangitis

Back 30

Pain, Fever, Jaundice (Charcot's triad), w/ hypotension and mental confusion

Front 31

What will you likely see on labs in cholangitis

Back 31

increased serum total bilirubin >2mg , CBC shows leukocytosis, LFT shows elevated AST, cultures may show aerobic and anaerobic gram neg bacteria

Front 32

What is the tx for cholangitis

Back 32

antibiotic therapy and ERCP with sphincterotomy

Front 33

What are the common biliary tract neoplasms

Back 33

gallbladder carcinoma, cholangiocarcinoma, adenocarcinoma of ampulla of vater.

Front 34

what is the tx for neoplasms of gallbladder and biliary tract

Back 34

surgical excision increases 5yr survival rate