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CM Biliary Dz
Biliary Disease
| Question | Answer |
|---|---|
| ____ ml/day of bile is secreted | 500-600ml, most bile is absorbed in the terminal ileum |
| total bilirubin and alk phos | produced by bile duct epithelium. |
| ALT and AST are produced by | liver parenchyma |
| Xrays | not used often, but if pt already has one, you can look for gallstones (not all are radiopaque), fistulas, porcelain GB, GS ileus, emphysematous cholecystitis |
| Gallstone test of choice | US |
| Bile duct stone test | CT or MRI |
| Where does the scope end in the ERCP? | Duodenum. Procedure needs to be done under X-ray with dye |
| Inject dye in patient's veins, which is taken by the liver, gallbladder and see if it is excreted into the small bladder | HIDA scan |
| Most sensitive and specific test for stones in the bile duct | Endoscope US |
| when are false positives seen in HIDA scans? | ill pts and fasting. |
| Catheter from outside put into the bile duct to drain infection | PTC |
| Gallstone epidemiology | 10% of general pop has, F:M 2:1 |
| Brown pigment stones are usually found | in the ducts |
| Black pigment stones | calcium bilirubinate in pts with cirrhosis and chronic hemolysis |
| generally x-rays show what percentage of stones? | 50% |
| Which stones are least radio opaque? | cholesterol |
| US sensitivity with stones | >95% for stones >2mm |
| HIDA scan in acute cholecystitis | gallbladder absent. All you see is liver |
| Hydrops | gallbladder gets bigger and bigger and leads to complications. Complicatoin of uncorreceted acute cholecystitis |
| ___ is commonly seen in DM and old pts; pockets of air are seen on imaging | Emphysematous cholecystitis. |
| Most effective procedure for detecting and removing the stones in choledocholithiasis | ERCP |
| ___ is highly accurate for CBD stones | EUS. invasive and expensiev. No risk of pancreatitis compared to ERCP |
| High Risk with ERCP | Pancreatitis. |
| ___ requires emergent ERCP/PTC with abx | Cholangitis |
| Pneumobilia is seen on imaging with | Cholecytoenteric fistula |
| What action should be taken if you seen Porcelain GB | Prophylactic cholecystectomy b/c of the high risk of cancer development |
| Stone in the cystic duct compressing of fistulizing into the common bile duct causes | Mirizzi's syndrome |
| Young middle aged females who present with episodic RUQ/epigastric pain. Nl PE, lab and imaging | Acalculous biliary pain |
| Strawberry GB | Cholesterolosis. Deposition of cholesterol esters and Triglycerides in the wall of the gall bladder. Polyps form in GB, leave GB and obstruct ampulla which can lead to pancreatitis |
| Benign condition involving proliferation and invaginationof surface epithelium | Adenomyomatosis |
| Whipple's surgery is preformed in | Ampullary tumor |
| Acholic or "silver" stools are seen in | Ampullary tumor |
| Diffuse intra- and extrahepatic bile duct inflammation and fibrosis | Primary Sclerosing Cholangitis. HTN in ducts leads to cirrhosis and portal HTN |
| Majority of PSC cases are related to | Ulcerative Colitis |
| Gold standard diagnosis for PSC | ERCP. Beads on a string appearance of fibrosis |
| Ulcerative Colitis patients should be monitored for | PSC and cholangiocarcinoma |
| Dilations and Strictures are found in | PSC |
Created by:
ltm12