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Glossary of IM GI Biliary tree USMLE 2

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What stimulates the gallbladder contraction (specifically)
Fat and Amino Acids in the proximal duodenum causes release of CCK
Dx:
Middle-aged female patient presenting w/ pruritis and an elevated Alk Phos w/ a normal Bilirubin.

What is the best initial test?

what is the most accurate test?
Dx:
Primary Biliary Cirrhosis

initial test:
Anti-mitochondrial Ab test

most accurate:
Liver Bx
Risk factors for cholelithiasis
(8 F's)

Two others?
Female;
Fat;
Forty;
Fertile;
Fibrosis (Cystic);
Familial;
Fasting;
F-Hgb (Sickle cell)

Also: DM and Oral contraceptives
Dx:
RUQ pain that lasts 2-6 hours, most often after fatty meal, N/V, RUQ tenderness w/o guarding or rebound
Cholelithiasis
What labs are elevated w/ gallstones?
Alkaline phoshatase

Bilirubin
(direct more then indirect)
when should HIDA scan be answered?
(2)
1. Gallstones and US Murphy's sign w/o Gallbladder edema

2. Gallbladder edema and US Murphy's sign w/o Gallstones

(if Dx is obvious, then do not answer HIDA scan)
First Dx test of choice for gallstones?
Ultrasound
Out of the (3) types of gallstones, name them in least common to most.
1. Cholesterol (10%)

2. Pigment (20%)

3. mixed (70%)
When are Radiolucent cholesterol gallstones seen?
(3)
rapid weight loss;

Oral contraception;

Ileal disease
When are radiodense pigment gallstones seen?
Hemolysis
Treatment of gallstones in order
(1 med; 2 procedures)
1. Chenodeoxycholate

2. Lithotripsy

3. Cholesystectomy
Dx:
Patient has high fever, chills, RUQ abdominal pain and jaundice. She has a history of UC and is complaining of pruritus with a negative hepatitis profile and a negative US.

Next step?
Dx: Primary Sclerosing Cholangitis

next step: ECRP
(4) bugs that can cause cholecystitis
BEEK:
Bacteriodes
E.coli
Enterococcus
Klebsiella
Dx:
RUQ pain often longer then 6 hours, possible guarding and rebound, fever, tachycardia, + Murphy's sign
Cholecystitis
Sign:
the arrest of inspiration while palpating the RUQ.

what is the Dx if positive?
Murphy's sign

Dx: Acute cholecystitis
Dx test of choice for cholecystitis
HIDA:

labeled iminodiacetic acid is injected IV and taken up by hepatocytes. Normal gallbladder is outlined in 1 hour, absence of visable gallbladder = cholecystitis
What condition is an ERCP most accurate for?
Primary Sclerosing Cholangitis
Tx for cholecystitis in order
(2 meds; 1 procedure)
Pain control;

2nd or 3rd generation Cephalosporin;

Cholecyctectomy
Definition:
complete obstruction of the biliary outflow tract due to a stone obstructing the common bile duct, a stricture or tumor. The patient becomes septic and it is life threatening
Ascending cholangitis
Definition:
stone obstruction of the common bile duct
Choledocholelithiasis
Charot's triad of Ascending Cholangitis

Reynolds pentad?
Charot's triad:
RUQ pain;
Jaundice;
Fever

Reynold's pentad:
Shock (hypotension);
Altered mental status
*Tx of choice for Ascending cholangitis
ERCP w/ endoscopic sphinctorotomy
Definition:
Chronic progressive disorder of unknown eitology characterized by inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic biliary tree.
What is it associated with?
Primary sclerosing Cholangitis


Assoc w/: Ulcerative Colitis
Dx:
34-yo man w/ a hx of ulcerative colitis presents w/ jaundice and elevated GGT and alk-phos.
Primary Sclerosing Cholangitis
ERCP showing "beads on a string" appearance
Primary Sclerosing Cholangitis

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