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25 Cards in this Set
- Front
- Back
- 3rd side (hint)
What stimulates the gallbladder contraction (specifically)
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Fat and Amino Acids in the proximal duodenum causes release of CCK
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Dx:
Middle-aged female patient presenting w/ pruritis and an elevated Alk Phos w/ a normal Bilirubin. What is the best initial test? what is the most accurate test? |
Dx:
Primary Biliary Cirrhosis initial test: Anti-mitochondrial Ab test most accurate: Liver Bx |
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Risk factors for cholelithiasis
(8 F's) Two others? |
Female;
Fat; Forty; Fertile; Fibrosis (Cystic); Familial; Fasting; F-Hgb (Sickle cell) Also: DM and Oral contraceptives |
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Dx:
RUQ pain that lasts 2-6 hours, most often after fatty meal, N/V, RUQ tenderness w/o guarding or rebound |
Cholelithiasis
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What labs are elevated w/ gallstones?
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Alkaline phoshatase
Bilirubin (direct more then indirect) |
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when should HIDA scan be answered?
(2) |
1. Gallstones and US Murphy's sign w/o Gallbladder edema
2. Gallbladder edema and US Murphy's sign w/o Gallstones (if Dx is obvious, then do not answer HIDA scan) |
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First Dx test of choice for gallstones?
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Ultrasound
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Out of the (3) types of gallstones, name them in least common to most.
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1. Cholesterol (10%)
2. Pigment (20%) 3. mixed (70%) |
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When are Radiolucent cholesterol gallstones seen?
(3) |
rapid weight loss;
Oral contraception; Ileal disease |
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When are radiodense pigment gallstones seen?
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Hemolysis
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Treatment of gallstones in order
(1 med; 2 procedures) |
1. Chenodeoxycholate
2. Lithotripsy 3. Cholesystectomy |
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Dx:
Patient has high fever, chills, RUQ abdominal pain and jaundice. She has a history of UC and is complaining of pruritus with a negative hepatitis profile and a negative US. Next step? |
Dx: Primary Sclerosing Cholangitis
next step: ECRP |
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(4) bugs that can cause cholecystitis
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BEEK:
Bacteriodes E.coli Enterococcus Klebsiella |
BEEK
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Dx:
RUQ pain often longer then 6 hours, possible guarding and rebound, fever, tachycardia, + Murphy's sign |
Cholecystitis
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Sign:
the arrest of inspiration while palpating the RUQ. what is the Dx if positive? |
Murphy's sign
Dx: Acute cholecystitis |
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Dx test of choice for cholecystitis
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HIDA:
labeled iminodiacetic acid is injected IV and taken up by hepatocytes. Normal gallbladder is outlined in 1 hour, absence of visable gallbladder = cholecystitis |
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What condition is an ERCP most accurate for?
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Primary Sclerosing Cholangitis
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Tx for cholecystitis in order
(2 meds; 1 procedure) |
Pain control;
2nd or 3rd generation Cephalosporin; Cholecyctectomy |
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Definition:
complete obstruction of the biliary outflow tract due to a stone obstructing the common bile duct, a stricture or tumor. The patient becomes septic and it is life threatening |
Ascending cholangitis
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Definition:
stone obstruction of the common bile duct |
Choledocholelithiasis
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Charot's triad of Ascending Cholangitis
Reynolds pentad? |
Charot's triad:
RUQ pain; Jaundice; Fever Reynold's pentad: Shock (hypotension); Altered mental status |
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*Tx of choice for Ascending cholangitis
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ERCP w/ endoscopic sphinctorotomy
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Definition:
Chronic progressive disorder of unknown eitology characterized by inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic biliary tree. What is it associated with? |
Primary sclerosing Cholangitis
Assoc w/: Ulcerative Colitis |
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Dx:
34-yo man w/ a hx of ulcerative colitis presents w/ jaundice and elevated GGT and alk-phos. |
Primary Sclerosing Cholangitis
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ERCP showing "beads on a string" appearance
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Primary Sclerosing Cholangitis
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