Icm Winter 5 Biliary

Front 1

1. Cholelithiasis
2. Cholecystitis
3. Cholecystectasia
4. Choledocholithiasis
5. Cholangitis
6. primary sclerosing cholangitis-

Back 1

1. Cholelithiasis- stone in GB
2. Cholecystitis- inflammation of GB
3. Cholecystectasia- dilation of GB
4. Choledocholithiasis- stone in common BD
5. Cholangitis- inflam of bile ducts
6. Primary sclerosing cholangitis- fibrosis of intra/extra hepatic bile ducts. see in UC, presents with recurrent/presistent obstructive jaundice

Front 2

1. biliary colic
2. HIDA
3. GB dyskinesia
4. Gallstone Illeus

Back 2

1. biliary colic- pain bc of contraction/stones
2. HIDA- 99m technetium labeled hepatobiliary imaging
3. GB dyskinesia- poor ejection from GB
4. Gallstone Illeus- sm intest obstruction due to large stone that errodes through GB into the duodenum, producing cholecystomenteris fistula and then gets into small bowel

Front 3

1. what is a stone in GB
2. what is inflammation of GB
3. what is dilation of GB
4. what is removal of GB
5. what is stone in common bile duct
6. what is pain when GB contracts
7. what is inflammation of biliary tree
8. what is when the GB contracts bad
9. what is used to see the biliary system
10. what is it called when a gallstone gets into sm intestion and blocks it

Back 3

1. Cholelithiasis
2. Cholecystitis
3. Cholecystectasia
4. cholesystectomy
5. Choledocholithiasis
6. biliary colic
7. Cholangitis
8. biliary dyskinesia
9. HIDA
10. gallstone illeus

Front 4

what are the types of gallstones

Back 4

1. Cholesterol

2. Pigment

3. Ca Carbonate

4. Mixed:

Front 5

what are the 5 F of gallstone disease

Back 5

1. female
2. fart
3. fat
4. fertile
5. forty

Front 6

what makes up Charcots Triad and what does it suggest, how about Reynolds Pentad

Back 6

Charcots:
1. RUQ pain
2. fever w/chills
3. jaundice

*

Reynolds
1.
2.
3.
4.

Front 7

what nationality gets more cholelithiasis

Back 7

women, native americans- Pima

Obesity and DM are factors

Front 8

what are stones make of

Back 8

cholesterol
lecithin
bile acids

**when bile salts decrease and cholesterol is increased --> ppt out stones

Front 9

risk factors for cholelithiasis

Back 9

obesity, cholesyscetomy in 1st degree relative, native america, old, women, rapid weight loss, glucose intolerance, increased insulin levels, ileal resection, chrons, DM, hypertriglyceridemia, cirrhosis, drugs, long fast (turn to slugde bc GB wont contract)

Front 10

what can decrease gallstone formation

Back 10

low carb
high fiber
low fat
exercise
caffeine in coffee

*vit c, NSAIDS, ASA

Front 11

what is the main component in the following type of gall stones

1. pigment
2. cholesterol
3. Ca Carbonate
4. Mixed

Back 11

1. Pigment: Ca bilirubinate, uncong bili ppt, Fe from bili lights them up on x ray

2. cholesterol- duh, its from excess cholesterol in bile. common in women fatties who have had kids, DM

3. Ca Carbonate: uncommon in adults, more common in kids

4. mixed-

Front 12

what are sx of cholelithiasis

Back 12

transient
related to eating fatty meals, when BG contracts it hits cystic duct and causes pain

NV, bloat, fart, RUQ pain, R shoulder pain

NO peritoneal signs: not localized, no rebound tenderness

Front 13

whats on the ddx of biliary colic

Back 13

1. cholycystisis
2. PUD
3. hepatitis
4. pneumonia

Front 14

what is dx test for gallstones

Back 14

US- will have acoustic shadow

** can be (-) if pts pain persits and your suspicion is high can do endoscopic US or HIDA US with CCK- CCK makes GB contract, wth stones EF is low

Front 15

do you see acoustic shadow on US for stones or polyp

Back 15

stones

Front 16

tx for gall stones

Back 16

NPO- dont want to stim GB, NSAIDS, wait it out.

**can do surgery, elective. low fat high fiber diet in teh meantime

Front 17

what is the prognosis of taking orals to dissolve gall stones

Back 17

not great

Front 18

tell me about acute cholcystitis

Back 18

inflammation of GB

PERSISTANT pain, + murphy sign, push your hand up the GB and pt stops breathing

pain to R scapula

peritoneal signs present: guarding, q

Front 19

what are hte labs for acute cholecystitis

Back 19

guarding
murphy
US- thick GB wall, pericholecystic fluid, stones +/-

Front 20

whats HIDA

Back 20

dye that follows bile, can tell you where an obsturction is

can also use CCK adn see teh ejection fraction

Front 21

whats the complication of acute cholecystitis

Back 21

gangrene- most common
perforation
cholecystenteric fistula
gallstone ileus
emphysematous cholecystitis

Front 22

tell me about choledocholithisasis

Back 22

stone in common bile duct- pain, NV

obstructive jaundice: dark pee and pale pooleukocytosis

liver fx tests are high adn LOTS of cong bili, alk phos increased. GGT high

Front 23

when is cong bili high, GGt high and liver enzymes high

Back 23

stoned in common bile duct

choledichilithiasis

Front 24

what is ERCP

Back 24

endoscopic retrograde cholangiopancreatography

*great way to see the cause location and extent of obstruction
*make dx, take out stone and place stent

complications of procedure include pancreatitis (HIDA risk was bile duct injury

Front 25

do choecystectomy asap if you have stones in common bile duct (choledocholithiasis) T or F

Back 25

treu

Front 26

WHAT IS Acute cholangitis

Back 26

inflammation of biliary duct system

ascending infection of biliary bc of obstruction in: common bile duct, or strictures

potentially fatal

caused by E coli, klebsiella, enterobacter

Front 27

what signs tell us there is a high morbidity in acute cholangitis

Back 27

charcots: pain, fever, jaundice
Reynolds
mental status change
hypotension

Front 28

what is reynolds pentad

Back 28

charchots (pain, jaundice, fever)+ alterd mental status + shock

**suggests ascending cholangitis

Front 29

what aer hte labs assoc w/acute cholangitis

Back 29

leukocytosis w/L shift
increased alk phos
increased GGT
increased direct bili
US: common BD stone/dilation

tx w/ERCP

Front 30

can gallstones cause pancreatitis

Back 30

yep

tx w/GB removal

Front 31

flow chart

acute biliary pain

where do you go if it is short lived w/no fever or leukocytosis

what about prolonged with fever, murphy, leukocytosis

Back 31

1. billiary colic, gallstones

2. acute cholcystitis

Front 32

GB thickened pericholcystatic fluid increased WBC gever, gallstones, pain

Back 32

acute cholcystitis

**tx with cholecystectomy

Front 33

RUQ pain w.no GB thickening or fever or infection and stones presnet

Back 33

cholethiasis

Front 34

Gallstones present, increased bili, increased alk phos, dilated biliary tree

Back 34

choledocholitsis

Front 35

no gall stones, decreased EF

Back 35

biliary dyskinesia

Front 36

what does GB cancer look like

Back 36

porcelin (calcified)
not common