Biliary Popcorn 2

Question 1

Condition?

• CBD is MC location
• Bacteria infects bile
• Pus under pressure –> surgical emergency
• Fever / RUQ p / Jaundice
• Leuks >20,000
• Cholestasis: ↑conj bil, ↑alk phos
• Absent urobil on UA

Tx?

Answer 1

Ascending/Acute Cholangitis

Tx:

• Admit & consult gastroent emergently!
• Broad abx: piper-taco, Cef+Metro, Cipro+Metro
• ERCP w/ sphincterotomy & stone extraction, stent placement
• Follow w/ CCY

Question 2

Condition?

• Appears acutely ill
• Diaphoretic
• +fever, tachy, hypotension
• Icterus
• RUQ/Epi & guarding
• AMS**

Answer 2

Ascending/Acute Cholangitis

Question 3

Charcot’s Triad?

Which condition?

Answer 3

Ascending/Acute Cholangitis

• Fever/Chills
• RUQ pain
• Jaundice

Question 4

Reynolds Pentad?

Which condition?

Answer 4

Ascending/Acute Cholangitis

Charcot’s Triad:

• Fever/Chills
• RUQ pain
• Jaundice

+ Reynold’s

• Hypotension
• AMS

Question 6

• Temporary RUQ pain episodes
• No fever
• No leukocytosis
• No jaundice

Answer 6

Biliary Colic

Question 7

• Persistent RUQ pain
• Fever
• Leukocytosis
• No jaundice

Answer 7

Acute Cholecystitis

Question 8

• RUQ/epigastric pain
• Jaundice
• No fever
• No leukocytosis

Answer 8

Choledocholithiasis

Question 9

• RUQ/epigastric pain
• Jaundice
• Fever
• Leukocytosis

Answer 9

Ascending Cholangitis

Question 10

31 y/o female

• RUQ pain x 8 hours
• Fever
• Hx of 4 – 5 similar episodes
• Leukocytosis
• No obstruction: bilirubin normal

Answer 10

Acute Cholecystitis (sxs >6 hrs)

Question 11

Which condition?

• Females 35-60
• Autoimmune
• –> cirrhosis / liver failure

Answer 11

Primary Biliary Cirrhosis (PBC)

B=Breasts

Question 12

• Fatigue
• Pruritis à followed by jaundice
• Arthritis
• RUQ pain
• Hyperpigmentation of skin
• Xanthomas
• Hepatomegaly
• CREST sxs – limited scleroderma (Calcinosis under skin, Raynaud’s, Esophageal dysfunction, Sclerodactyly, Telangectasias)

Answer 12

PBC

Question 13

AMA is hallmark

ANA

Livery biopsy

Answer 13

PBC (primary biliary cirrhosis)

Question 14

Tx for PBC?

Answer 14

Urso

DEXA (bone density)

Question 15

Condition?

• MEN
• 75% w/ Ulcerative Colitis
• Inflammation/fibrosis of med-large ducts
• 10-12 yr survival after diagnosed

Tx?

Answer 15

Primary Sclerosing Cholangitis (PSC)

S= scrotum

Question 16

Condition?

• Steatorrhea
• Pruritis AFTER jaundice
• Fatigue
• P-ANCA, ASMA, ANA, IgM
• ERCP, MRCP
• Don’t do liver biopsy…

Answer 16

PSC

(Primary Sclerosing Cholangitis)

Question 17

Complications of PSC?

Answer 17

• Cirrhosis
• Osteoporosis
• Biliary stricture
• Cholangitis**
• Cholangiocarcinoma**
• Gallbladder cancer**
• Colon cancer (if IBD – Ulcerative Colitis is present)**

Question 18

Tx for PSC?

Answer 18

• DEXA
• ERCP
• Liver transplant (for advanced dz)

Question 19

Condition?

• Deficiency in enzyme for glucuronidation of bilirubin in liver (conjugation)
• Homozygous
• Suspect in pts w/ unconjugated hyperbilirubinemia in the absence of hemolysis
• NORMAL labs

Answer 19

Gilbert’s Syndrome

Question 20

Condition?

• Majority of biliary tract cancers (>50%)
• RF: cholelithiasis, gallbladder polyps >1cm, Salmonella infection
• Sxs of malignancy (anorexia / weight loss)

Answer 20

GB cancers

Question 21

Condition?

• Adenocarcinoma of bile ducts (intra/extra hepatic)
• Assoc w/ PSC & Choledochal cysts
• ***Jaundice+++
• Vague upper abd pain
• Anorexia
• weight loss

Answer 21

Cholangiocarcinoma

Question 22

Condition?

• Labs: cholestasis (obstructive pattern)
• ↑conjugated bilirubin & alk phos
• ↑ Tumor marker CA 19-9

Answer 22

Cholangiocarcinoma

Question 23

Condition?

• where CBD & pancreatic duct come together
• RARE
• Assoc w/ familial adenomatous polyposis (FAP) & Hereditary Non-Polyposis Colon Cancer (HNPCC)

Answer 23

Ampullary Cancer

Question 24

Condition?

• Obstructive jaundice (MC)
• Occult GIB à Microcytic Anemia
• Abdominal pain
• Microcytic Anemia

Answer 24

Ampullary Cancer