Term
| What are the two types of gallstones and which one is the most common? |
|
Definition
1) Cholesterol Stones - most common
2) Pigment stones |
|
|
Term
When are black pigment stones seen?
When are brown pigment stones seen? |
|
Definition
1) black-cirrhosis or hemolytic anemia
2) brown-Asians |
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|
Term
| What is the most common symptom of billiary stones? |
|
Definition
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|
Term
| What is the pain description for gallstones? |
|
Definition
1) localized to epigastrium
2) sudden onset
3) rapidly increasing intensity
4) plateaus and can last for 3 hours |
|
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Term
| What does pain lasting >6 hours and a fever suggest? |
|
Definition
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|
Term
| What is 90-95% of cholecystitis associated with? |
|
Definition
|
|
Term
| acalculous cholecystitis is more common in whom? |
|
Definition
elderly men who are critically ill following:
1) major surgery
2) severe trauma
3) extensive burns |
|
|
Term
| What are important clinical signs of acute cholecystitis? |
|
Definition
1) tenderness
2) guarding
3) rebound pain |
|
|
Term
| What is the diagnostic test of choice for stones >2mm in size? |
|
Definition
|
|
Term
| What is the most accurate means of diagnosing acute cholecystitis? |
|
Definition
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|
Term
| If febrile in acute cholecystitis what meds should you give? |
|
Definition
broad spectrum 3rd generation cephalosporins
1) ampicillin-sulbactam
2) piperacillin-tazobactam |
|
|
Term
| What are 5 complications of cholecystectomy |
|
Definition
1) localized perforation and abcess
2) empyema
3) emphysematous cholecystitis
4) cholecystenteric fistula
5) gallstones and malignancy |
|
|
Term
| What are 4 groups of people who have a high risk of gallbladder cancer? |
|
Definition
1) Pima Indians
2) Those with calcified gallstones
3) Those with very large stones >3cm
4) gallbladder polyp >10 mm |
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|
Term
| What is the clinical triad associated with choledocholithiasis? |
|
Definition
1) fever with shaking chills
2) jaundice
3) R upper quadrant colicky pain |
|
|
Term
| What labs rise markedly and abruptly with choledocholithiasis? |
|
Definition
1) serum bilirubin
2) alkaline phosphatase |
|
|
Term
| What diagnostic test shows visualization of stones in 90% of patients? |
|
Definition
|
|
Term
| What should be the initial treatment of choledocholithiasis with a success rate of 97%? |
|
Definition
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|
Term
| What are the 5 specific presentations of chronic biliary tract disease? |
|
Definition
1) common bile duct stricture
2) primary sclerosing cholangitis
3) pyogenic cholangitis
4) choledochal cyst
5) sphincter of Oddi dysfunction |
|
|
Term
| What is primary sclerosing cholangitis characterized by? |
|
Definition
| 1) irregular inflammatory fibrosis of both the intrahepatic and extrahepatic bile ducts |
|
|
Term
| What is present or will develope in 3/4 of patients presenting with primary sclerosing cholangitis? |
|
Definition
| chronic ulcerative colitis |
|
|
Term
| What parasites are often found in the stool with pyogenic cholangitis? |
|
Definition
1) opisthorchis sinensis
2) ascaris lumbricoides |
|
|
Term
| What triad exists with choledochal cysts? |
|
Definition
1) abdominal pain
2) mass
3) Jaundice
*fever commonly present |
|
|
Term
| What is biliary colic from gallstones caused by? |
|
Definition
| functional spasm of cystic duct |
|
|
Term
| What is Courvoisier's law? |
|
Definition
| palpable gallbladder is usually found w/gallstones and malignancy |
|
|
Term
| What is reynolds pentad for choledocholithiasis? |
|
Definition
1) fever w/shaking chills
2) Jaundice
3) R upper quadrant colicky pain
4) Mental Status changes
5) Shock |
|
|
Term
| beeding and pruning of the biliary tree is seen in what? |
|
Definition
| primary sclerosing cholangitis |
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