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