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16 Cards in this Set
- Front
- Back
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what is normal total bilirubin? what do you see first icterus or jaundice?
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total bilirubin= 1
see icterus first and then jaudice at around 3. |
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what is the + murphy's sign?
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The catch of breath that occurs when the gallbladder makes contact with your hand.
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what percentage of plain films show radiolucent stones in the RUQ for gallstones? which test is better and should be done first? which test shoudl be done second?
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15%- not useful
US= do 1st (90%) HIDA: do 2nd |
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what is the drawback associated w/ laparoscopic cholecystectomy? what do we do if we suspect choledoclethiasis?
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cannot explore the common duct for stones there (choledoclethiasis)--> if suspected do an open cholecystectomy.
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how do you tx a high risk cholelithiasis pt?
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US percutaneous aspiration of the gallbladder or ERCP w/ sphincterotomy & stone removal.
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what is the association between age and cholecystectomy mortality?
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in your 70s, the risk of mortality 2xs, and in your 80s it triples.
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what is the main cause of cholecsytitis? what are the 2 minor categories of causes?
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major- 90% from calculi
minor- 5% acalculus (micro crystal dz) 5% from other causes: like infection, AI, cholangitis, tumor, strictures, sphincter of oddi dysfunction |
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what are two manifestations of choledocholithasis?
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if above the pancreas: the stone is obstructing the liver + gallbladder = elevated ALT & AST
if above the pancreatic duct: you get liver + gallbladder + pancreatic sxs. |
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what can cause emphysema of the gallbladder?what is hydrops?
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air in the gallbladder--- d/t perforation or gas producing bacteria.
kids- distended gallbladder full of fluid that may not have anything to do w/ stones. Bile duct swelling shut d/t edema & the gallbladder just keeps getting larger. |
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what is the massive list of complications associated with cholecystitis?
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porcelin gallbladder
chronic cholecytitis pancreatitis hydrops emphysema empyema adenomatous wall changes choledocholithiasis gangrene fistula formation jaundice sepsis surgical morbidity DEATH |
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what is primary sclerosing cholangitis? what chronic illness is this associated w/ 70% of the time? what population has a decreased incidence of primary sclerosing cholangitis?
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nonmalignant obstruction of the ducts that comes from a nonbacterial source and results in progressive obliteration of intrahepatic & extrahepatic bile ducts;
ulcerative colitis dec incidence in smokers |
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what are the sxs and sns of primary sclerosing polyangitis?
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asymptomatic- mostly
some: charcot's traid: abdominal pain (RUQ), fever & jaundice w/ a clear US. some fat soluble deficiencies |
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what sxs signifies that the problem is coming from the duct?
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INTENSE PRURITIS
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what are the diagnostic tools used for primary sclerosing polyangitis? what will you see cholangiogram that is a big diagnostic clue for PSP?
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ERCP, elevated alkaline phosphatase and/or LFT's, elevated bilirubin
cholangiogram= "beading" of the bile ducts. |
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how do you tx primary sclerosing polyangitis? what tx completely cures them?
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ursodiol (stone melter)
MTX steroids antibiotics-- in case there is enough stasis that they dev bacterial infection secondary to this ERCO biliary stints curative: liver transplant |
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what are the two big worries associated w/ primary sclerosing polyangitis?
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higher risk of cholangiocarcinoma (10%) and inc risk of esophageal varices.
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