12. Gallstones and Surgical Jaundice Flashcards
What medication increases the risk of gallstones?
Clofibrate
What complications are associated with gallstones?
Acute cholecystitis Post acute cholecystitis Chronic cholecystitis Mirizzi syndrome Gallbladder carcinoma Gallstone ileus
What is the name given to gallbladder carcinomas on x ray?
“porcelain gallbladder”
What are the limitations of ultrasound?
Ultrasoundographer
Obese patient
Air
What is the management of acute cholecystitis?
Analgesia, fluids Abdominal ultrasound IV antibiotics (e.coli present in gallbladder) Nil PO if vomiting Laproscopic cholecystectomy
How is a stone in the common bile duct diagnosed?
Ultrasound first but MRCP more reliable
How is a stone in the CBD removed?
Urgent ERCP and sphincterectomy
What is Murphy’s sign?
Acute cholecystitis
Doctor puts their hand right below patient’s ribcage and asks them to breathe in
Diaphragm pushes gallbladder down and patient gasps
What is MRCP?
Magnetic Resonance Cholangiopancreatography
MRI of liver, gallbladder, pancreas
IV contrast used
What is ERCP?
Endoscopic Retrograde Cholangiopancreatography
Endoscope is passed into duodenum and through papilla
Dye injected and x ray used to visualise ducts
Instruments can be used to remove stones, stent
Why do you not get colic with ascending cholangitis?
No smooth muscle in bile duct
Why does ascending cholangitis quickly become septic?
Gram negative organisms in bile ducts have LPS, cause gram negative sepsis
What is the treatment for ascending cholangitis?
Broad spec antibiotics
ERCP for emergency decompression
What is the treatment for acute pancreatitis?
Urgent ERCP and sphincterectomy
Laproscopic cholecystectomy after resolution as high recurrence
What is surgical jaundice?
Due to intra or extra hepatic organic obstruction to bile flow
