Gallbladder and Biliary Disease - USMLE Step 2 Flashcards

clinical presentation
Terms Definitions
Pathogenesis of cholelithiasis
3 types of stones:
cholesterol (from bile supersaturated with cholesterol, hypomotile gb)

black pigmented stones (seen in hemolytic dz and alcoholic cirrhosis), from unconjugated bili

brown stones: from biliary tract infection
clinical features of cholelithiasis
most are asx
biliary colic
dx of cholelithiasis
ruq u/s
tx of cholelithiasis
none needed unless repeated bouts of biliary colic, then tx with cholecystectomy
complications of cholelithiasis
cholecystitis
choledocholithiasis
gallstone ileus
malignancy
pathogenesis of acute cholecystitis
obx of cystic duct --> inflammation of gb wall
clincal features of acute cholecystitis
ruq pain that may radiate to right shoulder

murphy's sign
dx of acute cholecystitis

what if initial study is negative?
ruq u/s: shows pericholecystic fluid

if u/s is negative, do hida scan to look for dye not filling gb
tx of acute cholecystitis
hydration, bowel rest, abx, pain meds

cholecystectomy
complications of acute cholecystitis
gangrenous cholecystitis
GB perforation
emphysematous cholecystitis
fistula with gallstone ileus
pathophys of gallstone ileus
gallstone enters bowel lumen via fistula with gb, gets stuck --> obx
pathogenesis of choledocholithiasis
gallstone gets stuck in cbd
what are the two types of stones seen in choledocholithiasis
primary: pigmented, orginate in cbd

secondary: from gb, then pass into cbd, usually cholesterol or mixed
clinical presentation of choledocholithiasis
most pts are asx for years
ruq pain +/- jaundice
dx of choledocholithiasis
ercp (shows cbd dilation)
tx of choledocholitiasis
ercp with sphincterotomy and stone extraction, stent placement
complications of choledocholithiasis
cholangitis
pancreatitis
biliary cirrhosis
pathogenesis of cholangitis
obx --> biliary stasis --> bacterial overgrowth and infection
clinical presentation of cholangitis
charcot's triad (fever, ruq pain, jaundice)
dx of cholangitis
ercp
hyperbilirubinemia
elevated lfts
tx of cholangitis
iv abx and ivf

once afebrile x 48 hrs, ercp
complications of cholangitis
hepatic abscess
risk factors for carcinoma of the gallbladder
gallstone
fistulas
porcelain gb
clinical findings of carcinoma of the gb
palpable gb
jaundice
biliary colic
weight loss
tx of carcinoma of the gb
surgery, but 90% die w/i first year of dx
porcelain gb
transmural calcification of gb, 50% risk of developing carcinoma of the gb
pathogenesis of primary biliary cirrhosis
destruction of the intrahelpatic bile ducts, with portal inflammation and scarring

autoimmune dz
clinical presentation of pbc
middle aged women with automimmune dz

fatigue
pruritis
ruq pain
dx of pbc
+AMA
cholestatic lfts
elevated alk phos
liver bx to confirm dx
tx for pbc
urodeoxycholic acid slows the progression and relieves sx

liver transplant is curative
pathogenesis of primary sclerosing cholangitis
thickening of bile duct walls and narrowing of their lumens
clinical presentation of psc
pt with uc, pruritis, and jaundice
dx of psc
ercp shows bead like strictures and dilations of intra and extra hepatic ducts
tx of psc
ercp + stent placement to relieve sx

liver transplant is curative
complications of psc
cholangiocarcinoma
recurrent cholangitis
portal htn
liver failure
pathogenesis of cholangiocarcinoma
tumor of extra or intrahepatic bile ducts

psc is a major risk factor
clinical presentation of cholangiocarcinoma
60 yo with obx jaundice and weight loss
dx of cholangiocarcinoma
ercp
tx of cholangiocarcinoma
most tumors are unresectable
ercp + stent placement can relieve sx
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