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50 Cards in this Set
- Front
- Back
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what are the (3) types of stones that cause cholelithiasis?
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cholesterol stones (yellow/green)
pigment stones (black/brown) mixed stones (majority of stones) |
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what are black pigment stones associated with?
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hemolysis
alcoholic cirrhosis |
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what are brown pigment stones associated with?
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biliary tract infections
(usually found in bile ducts) |
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when do patients with cholelithiasis typically report pain?
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after meals
at night |
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what is Boa's sign?
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referred right subscapular pain of biliary colic
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how do you diagnosis gallstones?
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RUQ US
(95% sensitivity/specificity for stones >2mm) CT/MRI are alternatives |
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what are the signs of biliary tract obstruction?
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incr ALK-P
incr GGT incr conjugted bilirubin/jaundice pruritus clay-colored stools dark urine |
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what is acute cholecystitis?
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obstruction of the cystic duct (not infection) -> acute inflamm of the gallbladder wall
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what are the findings of acute cholecystitis on US?
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thickened gallbladder wall
pericholecystic fluid distended gallbladder stones |
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what do you do when a an US is inconclusive for suspected acute cholecystitis?
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hepatoiminodiacetic acid (HIDA) radionucleotide scan
- if normal, acute cholecystitis can be ruled out |
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what is the definition of a (+) HIDA scan in the diagnosis of acute cholecystitis?
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when the gallbladder is not visualized within (4) hours of injection
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what is the treatment of acalculous cholecystitis?
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emergent cholecystectomy
(if too ill for surgery, perform percutaneous drainage of gallbladder with cholecystostomy) |
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what is choledocholithiasis?
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gallstones in the common bile duct (CBD)
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what is primary/secondary choledocholithiasis?
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primary originate in in the CBD (usually pigmented)
secondary originate in the gallbladder (95%) |
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what are the clinical symptoms of choledocholithiasis?
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RUQ/epigastric pain
jaundice (onset of symptoms can signal the develpment of life-threatening complications) |
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what are some complications of CBD stones?
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cholangitis
obstructive jaundice acute pancreatitis biliary colic biliary cirrhosis |
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what is the gold standard for diagnosis of choledocholithiasis?
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ERCP (95% sensitivity/specificity)
(US not sensitive - 50%) |
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what is the treatment of choledocholithiasis?
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ERCP w/ sphincterotomy
(stone extraction w/ stent placement) |
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what is cholangitis?
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infection of biliary tract secondary to obstruction
(leads to biliary stasis and bacterial overgrowth) |
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what is Charcot's triad
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RUQ pain
jaundice fever (50-70% of cholangitis pts) |
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what should you do in pts with cholangitis?
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blood cx
IV fluids IV antibiotics (after blood cx) decompress CBD (when pt stable) |
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what is Reynolds' pentad?
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Charcot's triad
- RUQ pain - jaundice - fever and . . . - septic shock - altered mental status (emergency - rapidly fatal) |
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what do the labs of a pt with choledocholithiasis look like?
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total bilirubin: elevated
direct bilirubin: elevated ALK-P: elevated |
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what are the laboratory findings in a pt with cholangitis?
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hyperbilirubinemia
leukocytosis mild elevation of transaminases (ALT/AST) |
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what are the imaging studies used for the diagnsosis of cholangitis?
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RUQ US is initial study
cholangiography (PTC or ERCP) is definitive |
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when should you get the different types of cholangiography (PTC/ERCP) in cholangitis?
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PTC - when duct system is dilated (per US)
ERCP - when duct system is normal (do none during acute phase of illness, must be afebrile for 48 hrs) |
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how do you treat cholangitis?
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IV antibiotics + IV fluids
cholangiography (after 48 hrs of being afebrile) - PTC: catheter drainage - ERCP: sphincterotomy - (laparotomy: T-tube insertion) |
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what are the major risk factors for carcinoma of the gallbladder?
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gallstones (most)
cholecystenteric fistula porcelain gallbladder |
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what is the prognosis of carcinoma of the gallbladder?
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dismal - 90% within 1 year
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what is primary sclerosing cholangitis (PSC)?
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chronic idiopathic progressive disease of intrahepatic/extrahepatic bile ducts characterized by thickening of bile ducts (narrowed lumen).
- leads to cirrhosis, portal HTN and liver failure |
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primary sclerosing cholangitis (PSC) has a strong association with what disease?
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UC in 50-70% of those w/ PSC
(note: course of PSC unaffected by colectomy for UC) |
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what are the diagnostic findings of primary sclerosing cholangitis (PSC)?
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bead-like stricturing (on ERCP/PTC)
cholestatic LFTs |
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what are common complications of primary sclerosing cholangitis (PSC)?
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cholangiocarcinoma (20-30%)
cholangitis (15%) secondary biliary cirrhosis -> portal HTN -> liver failure |
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what is the currative treatment of primary sclerosing cholangitis (PSC)?
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liver transplant
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how do you treat the pruritus associated with bilirubin buildup?
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cholestyramine
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what causes secondary biliary cirrhosis?
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chronic biliary obstruction from:
- mechanical obstruction - sclerosing cholangitis - cystic fibrosis - biliary atresia |
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what is primary biliary cirrhosis?
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chronic progressive cholestatic liver disease characterized by destruction of intrahepatic bile ducts w/ portal inflammation and scarring
- autoimmune - middle-aged women |
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what are the (4) laboratory findings in primary biliary cirrhosis?
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cholestatic LFTs (incr ALK-P)
(+) antimitrochondrial antibodies incr cholesterol, HDL incr IgM |
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how do you confirm the diagnosis of primary biliary cirrhosis?
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liver biopsy
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how do you treat primary biliary cirrhosis?
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cholestyramine (pruritus)
Ca, bisphosphonates, vit.D (osteoporosis) ursodeoxycholic acid (hydrophilic bile acid - slows dz progression) liver transplant (curative) |
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what is a cholangiocarcinoma?
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tumor of the intrahepatic or extrhepatic bile ducts
- adenocarcinomas (most) - 7th decade of life (mc) |
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what are the (3) locations of cholangiocarcinoma?
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proximal 3rd of CBD (mc - "Klatskin's tumor")
distal extrahepatic (most resectable) intrahepatic (least common) |
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what are the risk factors of cholangiocarcinoma?
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PSC (major)
UC choledochal cysts Clonorchis sinensis infestation |
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what is a Klatskin tumor?
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cholangiocarcinoma in the proximal third of the CBD
- at junction of R/L hepatic ducts - unresectable (poor prognosis) |
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how do you make the diagnosis of a cholangiocarcinoma?
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cholangiography (PTC/ERCP) for diagnosis and assessment of resectability
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who are choledochal cysts more common in?
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women (4:1)
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how do you treat choledochal cysts?
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surgical resection
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what does cholecystokinin (CCK) do?
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a hormone that relaxes the sphincter of oddi and contracts the gallbladder
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what is biliary dyskinesia?
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motor dysfunction of the sphincter of Oddi
- recurrent biliary colic - no evidence of gallstones |
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how do you make the diagnosis of biliary dyskinesia?
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HIDA scan:
- gallbladder fills with labeled radionucleotide - CCK is given IV - gallbladder ejection fraction |
