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36 Cards in this Set
- Front
- Back
1. Cholelithiasis
2. Cholecystitis 3. Cholecystectasia 4. Choledocholithiasis 5. Cholangitis 6. primary sclerosing cholangitis- |
1. Cholelithiasis- stone in GB
2. Cholecystitis- inflammation of GB 3. Cholecystectasia- dilation of GB 4. Choledocholithiasis- stone in common BD 5. Cholangitis- inflam of bile ducts 6. Primary sclerosing cholangitis- fibrosis of intra/extra hepatic bile ducts. see in UC, presents with recurrent/presistent obstructive jaundice |
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1. biliary colic
2. HIDA 3. GB dyskinesia 4. Gallstone Illeus |
1. biliary colic- pain bc of contraction/stones
2. HIDA- 99m technetium labeled hepatobiliary imaging 3. GB dyskinesia- poor ejection from GB 4. Gallstone Illeus- sm intest obstruction due to large stone that errodes through GB into the duodenum, producing cholecystomenteris fistula and then gets into small bowel |
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1. what is a stone in GB
2. what is inflammation of GB 3. what is dilation of GB 4. what is removal of GB 5. what is stone in common bile duct 6. what is pain when GB contracts 7. what is inflammation of biliary tree 8. what is when the GB contracts bad 9. what is used to see the biliary system 10. what is it called when a gallstone gets into sm intestion and blocks it |
1. Cholelithiasis
2. Cholecystitis 3. Cholecystectasia 4. cholesystectomy 5. Choledocholithiasis 6. biliary colic 7. Cholangitis 8. biliary dyskinesia 9. HIDA 10. gallstone illeus |
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what are the types of gallstones
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1. Cholesterol
2. Pigment 3. Ca Carbonate 4. Mixed: |
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what are the 5 F of gallstone disease
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1. female
2. fart 3. fat 4. fertile 5. forty |
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what makes up Charcots Triad and what does it suggest, how about Reynolds Pentad
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Charcots:
1. RUQ pain 2. fever w/chills 3. jaundice * Reynolds 1. 2. 3. 4. |
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what nationality gets more cholelithiasis
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women, native americans- Pima
Obesity and DM are factors |
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what are stones make of
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cholesterol
lecithin bile acids **when bile salts decrease and cholesterol is increased --> ppt out stones |
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risk factors for cholelithiasis
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obesity, cholesyscetomy in 1st degree relative, native america, old, women, rapid weight loss, glucose intolerance, increased insulin levels, ileal resection, chrons, DM, hypertriglyceridemia, cirrhosis, drugs, long fast (turn to slugde bc GB wont contract)
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what can decrease gallstone formation
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low carb
high fiber low fat exercise caffeine in coffee *vit c, NSAIDS, ASA |
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what is the main component in the following type of gall stones
1. pigment 2. cholesterol 3. Ca Carbonate 4. Mixed |
1. Pigment: Ca bilirubinate, uncong bili ppt, Fe from bili lights them up on x ray
2. cholesterol- duh, its from excess cholesterol in bile. common in women fatties who have had kids, DM 3. Ca Carbonate: uncommon in adults, more common in kids 4. mixed- |
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what are sx of cholelithiasis
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transient
related to eating fatty meals, when BG contracts it hits cystic duct and causes pain NV, bloat, fart, RUQ pain, R shoulder pain NO peritoneal signs: not localized, no rebound tenderness |
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whats on the ddx of biliary colic
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1. cholycystisis
2. PUD 3. hepatitis 4. pneumonia |
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what is dx test for gallstones
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US- will have acoustic shadow
** can be (-) if pts pain persits and your suspicion is high can do endoscopic US or HIDA US with CCK- CCK makes GB contract, wth stones EF is low |
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do you see acoustic shadow on US for stones or polyp
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stones
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tx for gall stones
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NPO- dont want to stim GB, NSAIDS, wait it out.
**can do surgery, elective. low fat high fiber diet in teh meantime |
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what is the prognosis of taking orals to dissolve gall stones
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not great
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tell me about acute cholcystitis
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inflammation of GB
PERSISTANT pain, + murphy sign, push your hand up the GB and pt stops breathing pain to R scapula peritoneal signs present: guarding, q |
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what are hte labs for acute cholecystitis
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guarding
murphy US- thick GB wall, pericholecystic fluid, stones +/- |
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whats HIDA
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dye that follows bile, can tell you where an obsturction is
can also use CCK adn see teh ejection fraction |
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whats the complication of acute cholecystitis
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gangrene- most common
perforation cholecystenteric fistula gallstone ileus emphysematous cholecystitis |
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tell me about choledocholithisasis
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stone in common bile duct- pain, NV
obstructive jaundice: dark pee and pale pooleukocytosis liver fx tests are high adn LOTS of cong bili, alk phos increased. GGT high |
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when is cong bili high, GGt high and liver enzymes high
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stoned in common bile duct
choledichilithiasis |
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what is ERCP
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endoscopic retrograde cholangiopancreatography
*great way to see the cause location and extent of obstruction *make dx, take out stone and place stent complications of procedure include pancreatitis (HIDA risk was bile duct injury |
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do choecystectomy asap if you have stones in common bile duct (choledocholithiasis) T or F
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treu
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WHAT IS Acute cholangitis
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inflammation of biliary duct system
ascending infection of biliary bc of obstruction in: common bile duct, or strictures potentially fatal caused by E coli, klebsiella, enterobacter |
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what signs tell us there is a high morbidity in acute cholangitis
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charcots: pain, fever, jaundice
Reynolds mental status change hypotension |
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what is reynolds pentad
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charchots (pain, jaundice, fever)+ alterd mental status + shock
**suggests ascending cholangitis |
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what aer hte labs assoc w/acute cholangitis
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leukocytosis w/L shift
increased alk phos increased GGT increased direct bili US: common BD stone/dilation tx w/ERCP |
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can gallstones cause pancreatitis
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yep
tx w/GB removal |
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flow chart
acute biliary pain where do you go if it is short lived w/no fever or leukocytosis what about prolonged with fever, murphy, leukocytosis |
1. billiary colic, gallstones
2. acute cholcystitis |
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GB thickened pericholcystatic fluid increased WBC gever, gallstones, pain
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acute cholcystitis
**tx with cholecystectomy |
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RUQ pain w.no GB thickening or fever or infection and stones presnet
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cholethiasis
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Gallstones present, increased bili, increased alk phos, dilated biliary tree
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choledocholitsis
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no gall stones, decreased EF
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biliary dyskinesia
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what does GB cancer look like
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porcelin (calcified)
not common |