CM- GI-7- Biliary Disease
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| What is cholelithiasis | presence of stones in the gall bladder
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| Who is most likely to suffer from cholelithiasis | female, pregnancy, pt > 40yrs, or w/ family history
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| What factors can predispose you to developing cholelithiasis | obesity, oral contraceptives, diabetes, rapid weight loss, estrogen replacement tx, ileal disease, decreased physical activity
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| What ethnicities are more prone to suffer from cholelithiasis | Hispanics, northern European and pima Indians, less common in African Americans except with sickle cell disease
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| If you have a pt on total parenteral nutrition what complication are they more prone to develop | cholelithiasis
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| What test can you order to dx cholelithiasis | oral cholecystography and Gallbladder ultrasound
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| This visualization technique is used to examine biliary tree (gallbladder, bile and pancreatic ducts) by combining x-ray and endoscopy useful for id of strictures and biopsy of lesions and gallstones | Endoscopic Retrograde cholangiopancreatography ERCP
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| What visualization technique of the gallbladder uses radioisotopes | Cholescintigraphy- HIDA scan hydroxy iminodiacetic acid scan
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| What does a HIDA scan show | shows gallbladder activity not especially useful for seeing stones though
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| what is cholecystogram | x-ray used to evaluate gallbladder
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| Who is more effected by cholecystitis | Men are more affected than women though women get gallstones more than men
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| What are the s/sx of cholelithiasis | 80% asymptomatic, upper right quadrant pain of constant boring quality, can also have referred pain to scapular or supracervical region. Onset starts within hours of eating
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| What will you see on physical exam of pt with cholelithiasis | normal unless having biliary colic then +murphy sign, severe intermittent cramping pain RUQ, occurs mostly at night, lasts from a few minutes to hours
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| What is the tx if pt develops acute cholecystitis | IV fluids, antibiotics, and analgesics then cholecystectomy should be done within 72hrs
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| When wouldn't you want to perform a cholecystectomy with acute cholecystitis | pt has diffuse peritonitis, acute gallbladder perforation, systemic sepsis, diabetes, patient develops acalculous acute cholecystitis in ICU, or emphysematous cholecystitis
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| When would you do an open cholecystectomy over laparoscopy | if gallbladder is extremely inflamed, infected or has large gallstones
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| your pt can't be put under general anesthesia and is having acute cholecystitis what can be done for them | put in a percutaneous cholecystostomy tube under local anesthesia. Tube can be removed in 6 weeks if it is acalculous
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| What are gallstones made of | cholesterol, bilirubin, calcium, other organic material only 10% are pure cholesterol
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| What will you see on labs if pt has cholelithiasis | normal labs unless obstruction then you get increased alk phos an bilirubin
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| When would you prefer to use MRCP (magnetic resonance cholangiopancreatography) over ERCP (endoscopic retrograde cholangiopancreatography) | Pediatric or Elderly pt, pt with co morbidity, acute pancreatitis, cholangitis. But it may miss low grade strictures and you can get false positives
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| What are some complications that can arise w/ cholecystitis | infection of gallbladder, mirizzi's syndrome (impacted gallbladder stone in cystic duct or neck of g.b.), cholecystoenteric fistula (erosion of stone through g.b wall, acute cholangitis
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| What treatment can be given to get rid of gall stones without removing gallbladder | direct solvent dissolution (methyl tertiary butyl ether), extracorporeal shock wabe lithotripsy (used on big stones >3cm), oral bile salts (ursodiol/chenodial for poor surgical candidates)
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| This is inflammation of Gallbladder w/o detectable stones and s/sx of biliary colic. Pt presents w/ fever and elevated amylase occurs with trauma, burn patients or immunosuppressed | Acalculous Cholecystitis
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| Who are at increased risk for developing acalculous cholecystitis | burn patients on ventilators, immunosuppressed, trauma pt on ventilators
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| Why is acalculous cholecystitis concerning | high mortality rate of 10-50% can be dx with HIDA scan that show gallbladder dyskinesia,
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| What is the most common cause of acute pancreatitis world wide | choledocholithiasis- bile duct stones that have migrated from gallbladder to common bile duct
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| What is recommended tx for choledocholithiasis | stone passes spontaneously in mild cases but cholecystectomy is recommended
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| This is associated with biliary obstruction and then infection of biliary tree 6-9% of pts with gallstones develop this | acute cholangitis
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| What is Charcot's triad of cholangitis | pain, fever, jaundice
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| What is Reynolds pentad a combination of Charcot's triad w/ two more concerning signs indicating an emergency cholangitis | Pain, Fever, Jaundice (Charcot's triad), w/ hypotension and mental confusion
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| What will you likely see on labs in cholangitis | increased serum total bilirubin >2mg , CBC shows leukocytosis, LFT shows elevated AST, cultures may show aerobic and anaerobic gram neg bacteria
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| What is the tx for cholangitis | antibiotic therapy and ERCP with sphincterotomy
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| What are the common biliary tract neoplasms | gallbladder carcinoma, cholangiocarcinoma, adenocarcinoma of ampulla of vater.
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| what is the tx for neoplasms of gallbladder and biliary tract | surgical excision increases 5yr survival rate
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