Biliary Disease
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| ____ ml/day of bile is secreted | 500-600ml, most bile is absorbed in the terminal ileum
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| total bilirubin and alk phos | produced by bile duct epithelium.
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| ALT and AST are produced by | liver parenchyma
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| 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
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| Gallstone test of choice | US
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| Bile duct stone test | CT or MRI
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| Where does the scope end in the ERCP? | Duodenum. Procedure needs to be done under X-ray with dye
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| 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
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| Most sensitive and specific test for stones in the bile duct | Endoscope US
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| when are false positives seen in HIDA scans? | ill pts and fasting.
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| Catheter from outside put into the bile duct to drain infection | PTC
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| Gallstone epidemiology | 10% of general pop has, F:M 2:1
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| Brown pigment stones are usually found | in the ducts
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| Black pigment stones | calcium bilirubinate in pts with cirrhosis and chronic hemolysis
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| generally x-rays show what percentage of stones? | 50%
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| Which stones are least radio opaque? | cholesterol
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| US sensitivity with stones | >95% for stones >2mm
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| HIDA scan in acute cholecystitis | gallbladder absent. All you see is liver
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| Hydrops | gallbladder gets bigger and bigger and leads to complications. Complicatoin of uncorreceted acute cholecystitis
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| ___ is commonly seen in DM and old pts; pockets of air are seen on imaging | Emphysematous cholecystitis.
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| Most effective procedure for detecting and removing the stones in choledocholithiasis | ERCP
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| ___ is highly accurate for CBD stones | EUS. invasive and expensiev. No risk of pancreatitis compared to ERCP
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| High Risk with ERCP | Pancreatitis.
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| ___ requires emergent ERCP/PTC with abx | Cholangitis
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| Pneumobilia is seen on imaging with | Cholecytoenteric fistula
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| What action should be taken if you seen Porcelain GB | Prophylactic cholecystectomy b/c of the high risk of cancer development
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| Stone in the cystic duct compressing of fistulizing into the common bile duct causes | Mirizzi's syndrome
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| Young middle aged females who present with episodic RUQ/epigastric pain. Nl PE, lab and imaging | Acalculous biliary pain
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| 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
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| Benign condition involving proliferation and invaginationof surface epithelium | Adenomyomatosis
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| Whipple's surgery is preformed in | Ampullary tumor
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| Acholic or "silver" stools are seen in | Ampullary tumor
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| Diffuse intra- and extrahepatic bile duct inflammation and fibrosis | Primary Sclerosing Cholangitis. HTN in ducts leads to cirrhosis and portal HTN
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| Majority of PSC cases are related to | Ulcerative Colitis
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| Gold standard diagnosis for PSC | ERCP. Beads on a string appearance of fibrosis
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| Ulcerative Colitis patients should be monitored for | PSC and cholangiocarcinoma
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| Dilations and Strictures are found in | PSC
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Created by:
ltm12