ABSITE – Biliary Correct Questions &
Answers(RATED A+)
What is Charcot's triad and Reynold's Pentad? - ANSWERFever*
Jaundice*
Right upper quadrant pain*
Shock
Altered mental status
**charcot's triad
What is the first step in management of acute cholangitis? - ANSWERInitiation of IVF
and antibiotics
Supportive care for septic shock, which may include starting vasopressors
**in 15% of cases, urgent (within 12-24 hours) endoscopic retrograde
cholangiopancreatography (ERCP) or percutaneous transheptic cholangiography
(PTC) may need to be performed** but the first step is resuscitation and abx
What are the three most common causes of cholangitis?
What is the most common bacteria associated with it?
What antibiotic coverage should you include? - ANSWERBiliary calculi
Malignancy
Benign strictures
E coli is the most common bacterial isolate
Klebsiella
Enterobacter
Enterococcus
*Typically treat with piperacillin-tazobactam in order to have Pseudomonas coverage
If you have elevated Alanine aminotransferase (ALT) what are the associated
disease pathologies? - ANSWERViral hepatitis (Hep C, B)
Diabetes
Congestive heart failure
Liver damage
Bile duct problems
Infectious mononucleosis
Myopathy
If you have elevated Total bilirubin (T bili) what are the associated disease
pathologies? - ANSWERHemolysis
Gilbert syndrome (mild liver disorder in which the liver does not properly process
bilirubin. Gilbert's syndrome is due to a mutation in the UGT1A1 gene)
Rotor syndrome (Rare cause of mixed direct and indirect hyperbilirubinemia,
relatively benign, autosomal recessive bilirubin disorder characterized by non-
, hemolytic jaundice due to the chronic elevation of predominantly conjugated
bilirubin)
Hepatitis
Biliary obstruction
Crigler-Najjar syndrome (Rare inherited disorder affecting the metabolism of bilirubin,
a chemical formed from the breakdown of the heme in red blood cells leading to
nonhemolytic jaundice, which results in high levels of unconjugated bilirubin and
often leads to brain damage in infants, autosomal recessive manner)
Dubin-Johnson syndrome (Rare, autosomal recessive, benign disorder that causes
an isolated increase of conjugated bilirubin in the serum. Classically, the condition
causes a black liver due to the deposition of a pigment similar to melanin. This
condition is associated with a defect in the ability of hepatocytes to secrete
conjugated bilirubin into the bile, and is similar to Rotor syndrome)
Cirrhosis
**must differentiate between direct and indirect to determine etiology of pathology
If you have elevated Aspartate aminotransferase (AST) what are the associated
disease pathologies? - ANSWERMyocardial infarction
Acute pancreatitis
Acute hemolytic anemia
Severe burns
Acute renal disease
Musculoskeletal diseases
Trauma
If you have elevated Alkaline phosphatase (ALP) what are the associated disease
pathologies? - ANSWERBiliary obstruction
Osteoblastic bone tumors
Osteomalacia
Osteoporosis
Hepatitis
Cirrhosis
Acute cholecystitis
Myelofibrosis
Leukemoid reaction
Lymphoma
Paget disease
Sarcoidosis
Hyperthyroidism
Hyperparathyroidism
Myocardial infarction
Pregnancy
If you have elevated Lipase what are the associated disease pathologies? -
ANSWERPancreatic obstruction
Pancreatic destruction
Gallbladder carcinoma diagnosed by depth of invasion. What are the
recommendations?
What does T1a mean?
Answers(RATED A+)
What is Charcot's triad and Reynold's Pentad? - ANSWERFever*
Jaundice*
Right upper quadrant pain*
Shock
Altered mental status
**charcot's triad
What is the first step in management of acute cholangitis? - ANSWERInitiation of IVF
and antibiotics
Supportive care for septic shock, which may include starting vasopressors
**in 15% of cases, urgent (within 12-24 hours) endoscopic retrograde
cholangiopancreatography (ERCP) or percutaneous transheptic cholangiography
(PTC) may need to be performed** but the first step is resuscitation and abx
What are the three most common causes of cholangitis?
What is the most common bacteria associated with it?
What antibiotic coverage should you include? - ANSWERBiliary calculi
Malignancy
Benign strictures
E coli is the most common bacterial isolate
Klebsiella
Enterobacter
Enterococcus
*Typically treat with piperacillin-tazobactam in order to have Pseudomonas coverage
If you have elevated Alanine aminotransferase (ALT) what are the associated
disease pathologies? - ANSWERViral hepatitis (Hep C, B)
Diabetes
Congestive heart failure
Liver damage
Bile duct problems
Infectious mononucleosis
Myopathy
If you have elevated Total bilirubin (T bili) what are the associated disease
pathologies? - ANSWERHemolysis
Gilbert syndrome (mild liver disorder in which the liver does not properly process
bilirubin. Gilbert's syndrome is due to a mutation in the UGT1A1 gene)
Rotor syndrome (Rare cause of mixed direct and indirect hyperbilirubinemia,
relatively benign, autosomal recessive bilirubin disorder characterized by non-
, hemolytic jaundice due to the chronic elevation of predominantly conjugated
bilirubin)
Hepatitis
Biliary obstruction
Crigler-Najjar syndrome (Rare inherited disorder affecting the metabolism of bilirubin,
a chemical formed from the breakdown of the heme in red blood cells leading to
nonhemolytic jaundice, which results in high levels of unconjugated bilirubin and
often leads to brain damage in infants, autosomal recessive manner)
Dubin-Johnson syndrome (Rare, autosomal recessive, benign disorder that causes
an isolated increase of conjugated bilirubin in the serum. Classically, the condition
causes a black liver due to the deposition of a pigment similar to melanin. This
condition is associated with a defect in the ability of hepatocytes to secrete
conjugated bilirubin into the bile, and is similar to Rotor syndrome)
Cirrhosis
**must differentiate between direct and indirect to determine etiology of pathology
If you have elevated Aspartate aminotransferase (AST) what are the associated
disease pathologies? - ANSWERMyocardial infarction
Acute pancreatitis
Acute hemolytic anemia
Severe burns
Acute renal disease
Musculoskeletal diseases
Trauma
If you have elevated Alkaline phosphatase (ALP) what are the associated disease
pathologies? - ANSWERBiliary obstruction
Osteoblastic bone tumors
Osteomalacia
Osteoporosis
Hepatitis
Cirrhosis
Acute cholecystitis
Myelofibrosis
Leukemoid reaction
Lymphoma
Paget disease
Sarcoidosis
Hyperthyroidism
Hyperparathyroidism
Myocardial infarction
Pregnancy
If you have elevated Lipase what are the associated disease pathologies? -
ANSWERPancreatic obstruction
Pancreatic destruction
Gallbladder carcinoma diagnosed by depth of invasion. What are the
recommendations?
What does T1a mean?
