Gallbladder, Biliary Tract Diseases

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Gallbladder, Biliary Tract Diseases
2011-07-03 18:37:35
gallbladder biliary tract

GB, biliary tract diseases
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  1. Cholesterol stones: risk factors
    obesity, diabetes, hyperlipidemia, mult preg, OCP, Crohn's disease, ileal resection, age >40, Native Am, cirrhosis, CF
  2. Pigment stones: black stones are associate with
    hemolysis, alcoholic cirrhosis
  3. Boas' sign
    referred R subscapular pain of biliary colic
  4. Acute cholecystitis: signs
    • RUQ tenderness +/- rebound
    • Murphy's sign
    • hypoactive bowel sounds
    • low grade fever
    • leukocytosis
  5. Complications of cholecystitis
    • gangrenous cholecystitis
    • perforation of GB
    • emphysematous cholecystitis
    • cholecystenteric fistula with gallstone ileus
    • empyema of GB
  6. Cholecystitis: treatment
    • conservative: hydration, NPO (bowel rest), analgesic, IV abx
    • surgery: cholecystectomy
  7. Choledocholithiasis: complications
    • cholangitis
    • obstructive jaundice
    • acute pancreatitis
    • biliary colic
    • biliary cirrhosis
  8. Cholangitis: clinical features
    • Charcot's triad: RUQ pain, fever, jaundice
    • Reynold's pentad: above + septic shock, altered mental status
  9. Cholangitis: lab findings
    hyperbilirubinemia, leukocytosis, mild elevation transaminases
  10. Primary Sclerosing Cholangitis: characteristics
    • chronic idiopathic disease of intra and/or extrahepatic bile ducts
    • strong association with UC
  11. PSC: diagnosis
    • ERCP: bead-like stricturing, dilatations
    • Labs: cholestatic LFTs
  12. PSC: complications
    • cholangiocarcinoma
    • recurrent bouts of cholangitis
    • progress to secondary biliary cirrhosis, portal HTN, liver failure
  13. Primary biliary cirrhosis: characteristics
    • chronic, progressive destruction of intrahepatic bile ducts w portal inflammation and scarring
    • autoimmune disease
    • most common in middle-aged women
  14. PBC: clinical features
    • fatigue
    • pruritis (early), jaundice (late)
    • RUQ discomfort
    • xanthomata
    • osteoporosis
  15. PBC: diagnosis
    • labs: cholestatic LFTs, +AMA, high cholesterol, HDL, IgM
    • u/s or CT: r/o obstruction
  16. PSC & PBC: treatment
    • only curative treatment is liver transplant
    • cholestyramine for symptomatic relief