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Flashcards in Gallbladder & Biliary Tract Disorders Deck (78)
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1

Which hormone stimulates the gallbladder to release bile into the duodenum?

Cholecystokinin (CCK)

2

What is bile used for?

Emulsify fats
Assist with the excretion of cholesterol

3

Types of Biliary Tract Disorders

Cholelithiasis
Choledocholithiasis
Acute cholecystitis
Cholangitis
Primary sclerosing cholangitis
Primary biliary cirrhosis
CA of the biliary tract
Hyperbilirubinemia

4

Define Cholelithiasis

Formation of gallstones which are solid concentrations of varying quantities of cholesterol, Ca, and bilirubin

5

What leads to the formation of cholesterol stones?

Supersaturation of bile with cholesterol and GB hypomotility

6

Types of Gallstones

Cholesterol (90%)
Pigmented (10%)

7

Types of Pigmented Gallstones

Black stones: contain Ca bilirubinate, associated with cirrhosis and hemolysis
Brown stones: associated with biliary tract stasis & infection

8

Major Risk Factors for the Development of Gallstones

Age
Female
Genetic
Pregnancy
Obesity
Rapid weight loss
Cirrhosis
Hemolytic anemias
Hypertriglyceridemia
Medications: BC, clofibrate, ceftriaxone, octreotide
Terminal ileal resection
Gallbladder stasis
Reduced physical activity

9

The 4 F's of Cholelithiasis

Fat
Fertile
Female
Forty

10

Signs/Symptoms of Cholelithiasis

Biliary colic
Steady RUQ pain radiates to back/R shoulder
Nausea
Pain after eating

11

Treatment of Cholelithiasis

Observation
Cholecystectomy

12

Consider Prophylactic Cholecystectomy in these Patients

Diabetics
Porcelain gallbladder
Sickle cell disease
Hereditary spherocytosis
Gastric bypass

13

Define Porcelain Gallbladder

Blue discoloration & brittle consistency
Due to calcification from excessive gallstones

14

Gallstone Complications

Gallstone ileus
Gallstone pancreatitis
Acute cholecystitis
Choledocholithiasis
Cholangitis
Bile duct injuries

15

Define Gallstone Ileus

Stone erodes through GB wall and develops a cholecystoenteric fistula leading to obstruction of narrowest segment of bowel causing ileus

16

Protective Factors of Cholelithiasis

Statins
Ascorbic acid
Coffee- caffeinated
Vegetable protein

17

Define Choledocholithiasis

Presence of gallstones within the common bile duct

18

Signs/Symptoms of Choledocholithiasis

RUQ/epigastric pain
N/V
LFT's elevated
Bilirubin & alkaline phosphatase may be elevated

19

Choledocholithiasis Imaging

Transabdominal ultrasound
Abdominal CT
ERCP
Intraoperative cholangiography or ultrasonography
Magnetic resonance cholangiopancreatography (MRCP)

20

What is the gold standard for diagnosis of choledocholithiasis?

ERCP

21

Advantages of an ERCP

Therapeutic option
Stone retrieval
Sphincterotomy

22

Complications of an ERCP

Pancreatitis
Cholangitis
Perforation of duodenum or bile duct
Bleeding

23

Advantage of an MRCP

Detects choledocholithiasis, neoplasms, strictures, biliary dilations
High sensitivity & specificity
Minimally invasive

24

Disadvantages of an MRCP

Cannot sample bile, test cytology, remove stone

25

Contraindications for an MRCP

Pacemaker
Implants
Prosthetic valves

26

Indications for an MRCP

Cholangitis not severe
Risk of ERCP high

27

Treatment for Choledocholithiasis

Remove the stone via ERCP, lithotripsy, lap CBD exploration

28

Define Acute Cholecystitis

Syndrome of RUQ pain, fever, and leukocytosis associated with gallbladder inflammation usually caused by cystic duct obstruction

29

Important Findings on H&P

RUQ/epigastric pain which radiates to right shoulder
Anorexia
N/V
Fever
+ Murphy's sign
Jaundice

30

Diagnostics of Acute Cholecystitis

LFT's & bilirubin elevated
CBC: left shift
CRP elevated
US: stones/sludge, pericholecystic fluid, distended GB, thickened GB wall
HIDA scan: failure of GB filling