6: Biliary tract disease Flashcards
What are two causes of biliary tract disease?
Gall stones
Bile duct cancer
Also: autoimmune disease and infection - seemingly not covered in this lecture
What are gallstones?
Solid lumps of crystalised cholesterol or bilirubin formed in the gallbladder
Most patients who have gallstones are (symptomatic / asymptomatic).
asymptomatic
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?
Cholestasis
Inflammation and infection
What are the three types of gallstone?
Cholesterol
Pigment (bilirubin)
Mixed
Gallstones usually form in the gallbladder itself.
Where can they rarely form?
Within the bile duct itself
What are the five Fs of gallstones?
Fat
Fertile
Females
Forties
(Fair i.e Caucasian)
___ women are at higher risk of developing gallstones.
Pregnant
Which inflammatory bowel disease predisposes you to develop gallstones?
Crohn’s disease
Why does Crohn’s disease increase your chances of developing gallstones?
Impaired bile salt reabsorption in distal ileum
⇒less recycling of bile salts
⇒altered composition leading to crystalisation
Large stones can erode through the wall of the gall bladder into the duodenum - what is this called?
Fistulation
Chronic inflammation caused by lodged gallstones causes the walls of the gallbladder to ___.
thicken
Gallstones which flow out of the gallbladder may become stuck where?
Cystic duct
Common bile duct
Ampulla of Vater
Ileocaecal valve
Biliary colic is a (disease / symptom) associated with gallstones.
symptom
Biliary colic is caused by the impaction of a gallstone - where?
Cystic duct
Where is pain located in biliary colic?
Where may it radiate?
RUQ
Back / shoulder (referral sites for liver & gallbladder nerves)
What symptoms are associated with biliary colic?
Dyspepsia
Nausea
Biliary colic pain lasts __ hours and comes on (acutely / gradually).
2-6 hours
gradually
What is acute cholecystitis?
What causes it?
Inflammation of the gallbladder
Gallstone in the cystic duct
In acute cholecystitis, the gallbladder is initially ___ and then becomes ___.
sterile
infected
In acute cholecystitis, the gallbladder becomes distended and painful because of __ build-up.
gas
How is a gallstones diagnosis made?
Ultrasound
CT scan
MRCP / ERCP
How are acute cholecystitis patients treated supportively?
Analgesia
IV antibiotics (for infection)
IV fluids
Nil by mouth
How is acute cholecystitis treated curatively?
Cholecystectomy (ASAP)
By what means are cholecystectomies carried out nowadays?
Laparoscopically
i.e keyhole surgery
What sign may be seen if a gallstone obstructs the common bile duct?
Jaundice
What inflammatory disease is caused by the obstruction of the common bile duct by a gallstone?
Cholangitis
If a gallstone blocks the CBD and the Sphincter of Oddi is closed, where can bile be redirected?
What does this cause?
Pancreas
Acute pancreatitis
What investigation can also be used to remove gallstones from the common bile duct?
ERCP
What are the two main causes of acute pancreatitis?
Gallstones
Alcohol
(GET SMASHED)
What occurs to cause the damage seen in acute pancreatitis?
Pancreatic tissue is digested by its own enzymes
How is acute pancreatitis caused by gallstones treated?
Cholecystectomy in fit patients
ERCP if frail
What is gallstone ileus?
Small bowel obstruction
caused by a gallstone lodging in the distal ileum
How can a gallstone reach the distal ileum in gallstone ileus?
Fistula between gallbladder and duodenum
The movement of a gallstone through the small intestine in gallstone ileus causes ___ pain.
colicky
What will patients present with in gallstone ileus?
Small bowel obstruction
How is gallstone ileus treated?
Laparotomy (opening of abdomen)
Removal of gallstone surgically
What surgery will be carried out 3 months after the treatment of a gallstone ileus?
Cholecystectomy
What is the gold standard investigation for gallstones?
Ultrasound
What is a malignant cancer of the biliary tract?
Cholangiocarcinoma
What is the clinical presentation of cholangiocarcinoma?
Jaundice
Weight loss
Anorexia
Fatigue
Where does cholangiocarcinoma tend to metastasise?
Lymph nodes
Liver
Peritoneum
What investigations are used to diagnose and stage cholangiocarcinoma?
Ultrasound
CT
ERCP
MRI
Cholangiocarcinoma tends to present (early / late).
late
Bismuth-Corlette stages for cholangiocarcinoma - higher stages = greater spread in biliary tract
What is the only curative treatment for cholangiocarcinoma?
Bile duct / liver resection
What treatment can be used to palliate symptoms caused by bile duct obstruction in cholangiocarcinoma?
Stenting
