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Gastrointestinal Week 7 2016/17 > 6: Biliary tract disease > Flashcards

6: Biliary tract disease Flashcards

1
Q

What are two causes of biliary tract disease?

A

Gall stones

Bile duct cancer

Also: autoimmune disease and infection - seemingly not covered in this lecture

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2
Q

What are gallstones?

A

Solid lumps of crystalised cholesterol or bilirubin formed in the gallbladder

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3
Q

Most patients who have gallstones are (symptomatic / asymptomatic).

A

asymptomatic

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4
Q

When the composition of bile is altered, it tends to become static in the biliary tract. What is this called?

What are consequences of this?

A

Cholestasis

Inflammation and infection

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5
Q

What are the three types of gallstone?

A

Cholesterol

Pigment (bilirubin)

Mixed

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6
Q

Gallstones usually form in the gallbladder itself.

Where can they rarely form?

A

Within the bile duct itself

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7
Q

What are the five Fs of gallstones?

A

Fat

Fertile

Females

Forties

(Fair i.e Caucasian)

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8
Q

___ women are at higher risk of developing gallstones.

A

Pregnant

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9
Q

Which inflammatory bowel disease predisposes you to develop gallstones?

A

Crohn’s disease

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10
Q

Why does Crohn’s disease increase your chances of developing gallstones?

A

Impaired bile salt reabsorption in distal ileum

⇒less recycling of bile salts

⇒altered composition leading to crystalisation

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11
Q

Large stones can erode through the wall of the gall bladder into the duodenum - what is this called?

A

Fistulation

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12
Q

Chronic inflammation caused by lodged gallstones causes the walls of the gallbladder to ___.

A

thicken

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13
Q

Gallstones which flow out of the gallbladder may become stuck where?

A

Cystic duct

Common bile duct

Ampulla of Vater

Ileocaecal valve

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14
Q

Biliary colic is a (disease / symptom) associated with gallstones.

A

symptom

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15
Q

Biliary colic is caused by the impaction of a gallstone - where?

A

Cystic duct

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16
Q

Where is pain located in biliary colic?

Where may it radiate?

A

RUQ

Back / shoulder (referral sites for liver & gallbladder nerves)

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17
Q

What symptoms are associated with biliary colic?

A

Dyspepsia

Nausea

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18
Q

Biliary colic pain lasts __ hours and comes on (acutely / gradually).

A

2-6 hours

gradually

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19
Q

What is acute cholecystitis?

What causes it?

A

Inflammation of the gallbladder

Gallstone in the cystic duct

20
Q

In acute cholecystitis, the gallbladder is initially ___ and then becomes ___.

A

sterile

infected

21
Q

In acute cholecystitis, the gallbladder becomes distended and painful because of __ build-up.

A

gas

22
Q

How is a gallstones diagnosis made?

A

Ultrasound

CT scan

MRCP / ERCP

23
Q

How are acute cholecystitis patients treated supportively?

A

Analgesia

IV antibiotics (for infection)

IV fluids

Nil by mouth

24
Q

How is acute cholecystitis treated curatively?

A

Cholecystectomy (ASAP)

25
Q

By what means are cholecystectomies carried out nowadays?

A

Laparoscopically

i.e keyhole surgery

26
Q

What sign may be seen if a gallstone obstructs the common bile duct?

A

Jaundice

27
Q

What inflammatory disease is caused by the obstruction of the common bile duct by a gallstone?

A

Cholangitis

28
Q

If a gallstone blocks the CBD and the Sphincter of Oddi is closed, where can bile be redirected?

What does this cause?

A

Pancreas

Acute pancreatitis

29
Q

What investigation can also be used to remove gallstones from the common bile duct?

A

ERCP

30
Q

What are the two main causes of acute pancreatitis?

A

Gallstones

Alcohol

(GET SMASHED)

31
Q

What occurs to cause the damage seen in acute pancreatitis?

A

Pancreatic tissue is digested by its own enzymes

32
Q

How is acute pancreatitis caused by gallstones treated?

A

Cholecystectomy in fit patients

ERCP if frail

33
Q

What is gallstone ileus?

A

Small bowel obstruction

caused by a gallstone lodging in the distal ileum

34
Q

How can a gallstone reach the distal ileum in gallstone ileus?

A

Fistula between gallbladder and duodenum

35
Q

The movement of a gallstone through the small intestine in gallstone ileus causes ___ pain.

A

colicky

36
Q

What will patients present with in gallstone ileus?

A

Small bowel obstruction

37
Q

How is gallstone ileus treated?

A

Laparotomy (opening of abdomen)

Removal of gallstone surgically

38
Q

What surgery will be carried out 3 months after the treatment of a gallstone ileus?

A

Cholecystectomy

39
Q

What is the gold standard investigation for gallstones?

A

Ultrasound

40
Q

What is a malignant cancer of the biliary tract?

A

Cholangiocarcinoma

41
Q

What is the clinical presentation of cholangiocarcinoma?

A

Jaundice

Weight loss

Anorexia

Fatigue

42
Q

Where does cholangiocarcinoma tend to metastasise?

A

Lymph nodes

Liver

Peritoneum

43
Q

What investigations are used to diagnose and stage cholangiocarcinoma?

A

Ultrasound

CT

ERCP

MRI

44
Q

Cholangiocarcinoma tends to present (early / late).

A

late

45
Q

Bismuth-Corlette stages for cholangiocarcinoma - higher stages = greater spread in biliary tract

A
46
Q

What is the only curative treatment for cholangiocarcinoma?

A

Bile duct / liver resection

47
Q

What treatment can be used to palliate symptoms caused by bile duct obstruction in cholangiocarcinoma?

A

Stenting

Gastrointestinal Week 7 2016/17 (9 decks)

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