Acute Cholecystitis And Biliary Colic Flashcards
Gallstone RF
Fair Fat Fertile Female Forty
Gallstone cause
Chol synth in liver. Is rel insol, held in sol by plips and bile salts.
Excess chol vs bile salt leads to lithogenic bile.
Stasis (oestrogen in preg) and gb dysfunc has a role.
Nidus of infec.
Crohns or hemicolectomy reduc bile salt reabs.
Gallstone types
chol domin mixed- most comm.
Black pigm stones- haemolytic anaemia (oxidised unconjug bili and Ca). Us in gb.
Brown bili, Ca, acid and bact action- anywh in bil tree.
Bil colic due to gallst obstruc cystic duct
Px
RUQ epig pain. Colicky but never stops compl.
Abrupt onset
May be exacerbated by fatty food
NV
NO SYS RESP eg WCC, pyrexia. No infec or inflamm.
GORD is a diff.
acute cholecystitis due to gallst
Stone stick longer cause inflamm and press. And water in bile is abs so more irritant.
Px
Inflamm and parietal perit inv Local tenderness and peritonism Pos murphys sign. Push and inhlae cause pain on R only. IS SYS RESP eg high WCC and pyrexia THICK GB WALL ON US.
Gallstone ileus rare
Gallstone to SI via eg fistual to duod.
Block narrow termin ileul and compacts.
Causes SI obstruc.
Gallstone ix
FBC, CRP, LFT, amylase, UE, WCC High ALP and bili High ALT indics hepatic jaundice cause US- CBD and intrahepatic duct dilat MRCP if susp CBD stone
Gallstone mx
Analgesia Fluids IV AB if cholecystitis (ecoli and kleb) Lap chole MRCP, ERCP if CBD stone- tx by chole with CBD exploration. Other- US lithotripsy Percut drain if unfit for surg ERCP alone to prev pancreatitis and jaund only
Gallstone complics
Bil colic Cholecystitis Mucocoele Gangrene or perforat Empyeme Fistula Mirizzi synd Gb cancer Obstructive jaundice Cholangitis Acute pancreatitis Gallstone ileus Choledocholithiasis- CBD stones Charcots triad- fever, RUQ pain, jaund Reynolds pentad- charcot plus mental obtundation and shock Pancreatitis- LFT and amylase
Pre hepatic jaund
Haemolysis
Gilberts
Crigler nagler
Hepatic jaund
Viral hep
Alc hep
Drug induced eg penicillins
Cirrhosis
Post hepatic jaund
Gallstone
Stricture
AI- sclerosing cholangitis, AI pancreatitis
Congenital eg choledochal cysts
Obstruc jaund malig
Hilar cholangiocarcinoma Gb CA Distal cholangiocarcinoma Ampullary tum Panc tum- most comm
Obstruc jaund ix
Hx- pain, fever, itch, alc, drugs, dark urine, pale poo.
Mass, hepatomeg, spenomeg, stigmata liver dis.
LFT, UE, FBC, ALP, bili
US
CT if periampullary
MRCP if other
Covoisiers law
Palpab gb and jaundlikely panc CA
As LT gallstone would cause shrink
