Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
Pathogenesis of cholelithiasis
|
3 types of stones:
cholesterol (from bile supersaturated with cholesterol, hypomotile gb) black pigmented stones (seen in hemolytic dz and alcoholic cirrhosis), from unconjugated bili brown stones: from biliary tract infection |
|
clinical features of cholelithiasis
|
most are asx
biliary colic |
|
dx of cholelithiasis
|
ruq u/s
|
|
tx of cholelithiasis
|
none needed unless repeated bouts of biliary colic, then tx with cholecystectomy
|
|
complications of cholelithiasis
|
cholecystitis
choledocholithiasis gallstone ileus malignancy |
|
pathogenesis of acute cholecystitis
|
obx of cystic duct --> inflammation of gb wall
|
|
clincal features of acute cholecystitis
|
ruq pain that may radiate to right shoulder
murphy's sign |
|
dx of acute cholecystitis
what if initial study is negative? |
ruq u/s: shows pericholecystic fluid
if u/s is negative, do hida scan to look for dye not filling gb |
|
tx of acute cholecystitis
|
hydration, bowel rest, abx, pain meds
cholecystectomy |
|
complications of acute cholecystitis
|
gangrenous cholecystitis
GB perforation emphysematous cholecystitis fistula with gallstone ileus |
|
pathophys of gallstone ileus
|
gallstone enters bowel lumen via fistula with gb, gets stuck --> obx
|
|
pathogenesis of choledocholithiasis
|
gallstone gets stuck in cbd
|
|
what are the two types of stones seen in choledocholithiasis
|
primary: pigmented, orginate in cbd
secondary: from gb, then pass into cbd, usually cholesterol or mixed |
|
clinical presentation of choledocholithiasis
|
most pts are asx for years
ruq pain +/- jaundice |
|
dx of choledocholithiasis
|
ercp (shows cbd dilation)
|
|
tx of choledocholitiasis
|
ercp with sphincterotomy and stone extraction, stent placement
|
|
complications of choledocholithiasis
|
cholangitis
pancreatitis biliary cirrhosis |
|
pathogenesis of cholangitis
|
obx --> biliary stasis --> bacterial overgrowth and infection
|
|
clinical presentation of cholangitis
|
charcot's triad (fever, ruq pain, jaundice)
|
|
dx of cholangitis
|
ercp
hyperbilirubinemia elevated lfts |
|
tx of cholangitis
|
iv abx and ivf
once afebrile x 48 hrs, ercp |
|
complications of cholangitis
|
hepatic abscess
|
|
risk factors for carcinoma of the gallbladder
|
gallstone
fistulas porcelain gb |
|
clinical findings of carcinoma of the gb
|
palpable gb
jaundice biliary colic weight loss |
|
tx of carcinoma of the gb
|
surgery, but 90% die w/i first year of dx
|
|
porcelain gb
|
transmural calcification of gb, 50% risk of developing carcinoma of the gb
|
|
pathogenesis of primary biliary cirrhosis
|
destruction of the intrahelpatic bile ducts, with portal inflammation and scarring
autoimmune dz |
|
clinical presentation of pbc
|
middle aged women with automimmune dz
fatigue pruritis ruq pain |
|
dx of pbc
|
+AMA
cholestatic lfts elevated alk phos liver bx to confirm dx |
|
tx for pbc
|
urodeoxycholic acid slows the progression and relieves sx
liver transplant is curative |
|
pathogenesis of primary sclerosing cholangitis
|
thickening of bile duct walls and narrowing of their lumens
|
|
clinical presentation of psc
|
pt with uc, pruritis, and jaundice
|
|
dx of psc
|
ercp shows bead like strictures and dilations of intra and extra hepatic ducts
|
|
tx of psc
|
ercp + stent placement to relieve sx
liver transplant is curative |
|
complications of psc
|
cholangiocarcinoma
recurrent cholangitis portal htn liver failure |
|
pathogenesis of cholangiocarcinoma
|
tumor of extra or intrahepatic bile ducts
psc is a major risk factor |
|
clinical presentation of cholangiocarcinoma
|
60 yo with obx jaundice and weight loss
|
|
dx of cholangiocarcinoma
|
ercp
|
|
tx of cholangiocarcinoma
|
most tumors are unresectable
ercp + stent placement can relieve sx |