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48 Cards in this Set

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What is in the Calot's triangle?

Common Bile Duct


Cystic Duct


Cystic artery

What is in the Hepatocystic triangle?

Inferior liver margin


Common Bile Duct


Cystic Duct

What is Cholelithiasis?

Gallstones

In which population is Cholelithiasis more common?

Women>Men 2:1

True or False


Cholelithiasis increases in incidence in both sexes and all races with age.

True

Most gallstone are


a. symptomatic


b. asymptomatic

B. asymptomatic (only 1-2% have risk of developing symptoms/yr)

What are the 3 main types of Cholelithiasis?

  • Cholesterol stones
  • Brown pigment stones
  • Black pigment stones

What is the most common type of Cholelithiasis and in which population does it occur in?

Cholesterol stones


4F's Female Forty Fat Febrile

In what setting is Brown pigment stones usually occurring in?

In the setting of biliary infections

When does Black pigment stones occur?

As a consequence of increase in bilirubin load, as occurs in hemolytic anemia

What is the clinical finding of Cholelithiasis?

It is asymptomatic

What is the laboratory finding of Cholelithiasis?

Normal

What diagnostic test if performed for Cholelithiasis?

Typically incidental finding on abdominal US

What is the treatment for Cholelithiasis?

None or


Prophylactic cholescystectomy

What is the most common complication of gallstone and 1 of the most common causes of surgical emergencies?

Acute cholelithiasis

What is acute cholelithiasis?

Impaction of a gallstone in the neck of the gallbladder- inhibits biliary drainage and distention and edema of the gallbladder wall ensue

What are the clinical findings for acute cholelithiasis?

RUQ abdominal pain


Murphy's sign (inhibition of inspiration by pain on palpation of RUQ)


Guarding


N/V


Fever-typical

What are the laboratory findings of acute cholelithiasis?

CBC (Leukocytosis)


LFT (Possible elevation of ALT, AST, Total bilirubin, ALK Phos), elevation of Amylase

What imaging studies can be done to diagnose acute cholelithiasis?

  • Abdominal US (may show gallstones but is not sensitive for acute cholelithiasis)
  • Cholescintigraphy (Hepatic Iminodiacetic Acid HIDA) Scan
  • Paraisopropyl Iminodiacetic Acid (PIPIDA) scan (reveals obstructive cystic duct, Measures Ejection fraction Normal >35%)

What is the treatment for acute cholelithiasis?

  • NPO
  • IV Hydration
  • IV Antibiotics (ciprofloxacin 500 mg IV qd, metronidazole (Flagyl) 500 mg IV q6h, ampicillin-sulbactam (Unasyn)
  • IV analgesics
  • Immediate cholecystectomy if mild symptoms
  • For moderate to severe symptoms, cholecystectomy after 2-4 d of therapy

Due to high risk of recurrence what should be performed first for acute cholelithiasis?

Laproscopic cholecyestectomy is always attempted first (5-10% chance of becoming open procedure)

What is acalculus cholecystitis?

Acute necroinflammatory disease of the gallbladder with a multifactorial pathogenesis, without the presence of cholelithiasis-10% and occurs due to chronic stasis of bile in the gallbladder

Which patients are more likely to get acalculus cholecystitis?

Critically ill patients (trauma, burns, prolonged fasting) and Immunosuppressed patients (HIV/AIDS)

What is Choledocholithiasis?

Choledocholithiasis is the common bile duct stones which is the most common cause of cholangitis

What is Cholangitis?

Oobstruction of the bile duct by choledocholithiasis complicated with bacterial infection (originates from intestinal flora)

What are the clinical findings of Choledocholithiasis/Cholangitis?

Charcot triad (right upper quadrant abdominal pain, fever, jaundice)


Mental status changes


Hypotension

What is Reynolds pentad?

It is a combination of Charcot's triad (jaundice, fever, abdominal pain (usually RUQ)) with shock and an altered mental status that diagnoses obstructive ascending cholangitis

What are the laboratory findings of Choledocholithiasis/Cholangitis?

Leukocytosis


LFTs Alk Phos very high, Bilirubin > 3 mg/dL, Trasaminase very high >1000 unit/L , PT/INR elevated

Which imaging studies will show dilated bile duct?

US and CT

Which imaging studies will show an accurate demonstrating bile stone and can be used in pots thought to be at intermediate risk for choledocholithiasis?

MRCP

Which imaging study is the most accurate and can be therapeutic?

ERCP

What is the treatment for Choledocholithiasis/Cholangitis??

Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy (2-5% chance of postoperative pancreatitis)

What is Mirizzi Syndrome?

External compression of the common hepatic duct from a large stone lodged in the cystic duct

True or False


Mirizzi Syndrome is an uncommon disorder with 0.1% of all patients with gallstones.

True

What are the clinical findings for a patient with Mirizzi Syndrome?

Cholestasis, pain, jaundice

What imaging studies can be done to diagnose Mirizzi Syndrome?

US, CT, MRCP

What is the most common biliary tract malignancy?

Gallbladder cancer

What is the prognosis for gallbladder cancer?

Very poor prognosis because usually diagnosed at advanced stage


5 yr survival rate 0-10%


Present in 2% of elective cholecystectomy pts.

What are the risk factors for gallbladder cancer?

Gallstones (65-90% of cancer pts have gallstones and 1-3% of pts with known gallstones develop g. cancer)


Calcified gallbladder


Gallbladder polyps >1cm=cholecystectomy


Anomalous pancreticobiliary duct anatomy


Obesity


Estrogen

What imaging studies are done to show polypoid lesion without acoustic shadowing for gallbladder cancer?

US

What imaging studies are done to diagnose and stage gallbladder cancer?

EUS

What imaging studies are done to confirm extent of spread and involvement of vessels and lymph nodes gallbladder cancer?

CT, MRI

How do you treat gallbladder cancer?

Surgical resection


Adjuvant radiation and chemotherapy

What is cholangiocarcinoma?

Tumors that arise from the biliary tract (low incidence and poor prognosis 5 yr survival rate 20-35% with successful resection)

What are risk factors for cholangiocarcinoma?

Primary Sclerosing cholangitis


Ulcerative colitis


Intrahepatic bile duct stones


Liver flue infestation

What are the clinical findings of cholangiocarcinoma?

Painless jaundice


Pruritis


Weight loss

What laboratory findings are seen in pt with cholangiocarcinoma?

CA19-9 may be elevated, but not specific (pancreatic, colorectal, esophageal, hepatocellular cancer)


What imaging studies are done to diagnose cholangiocarcinoma?

The modality of choice is MRCP