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CP3 @ UoN - Medicine & Surgery > Acute & Chronic Gallbladder Disease & Carcinoma of the Biliary Tract > Flashcards

Acute & Chronic Gallbladder Disease & Carcinoma of the Biliary Tract Flashcards

1
Q

What are the common types of gallstone?

A

Cholesterol stones

Bile pigment stones

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2
Q

How do cholesterol stones form?

A

Cholesterol crystallisation w/i gall bladder

Due to excess cholesterol secretion/loss of bile salt

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3
Q

What are the risk factors for cholesterol stones?

A 
Age
Obesity, high fat diet
Rapid wt loss
Female, multiparity, pregnancy, OCP
DM
Ileal disease
Liver cirrhosis
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4
Q

How do bile pigment stones form?

A

Contain calcium bilirubinate

Form independently of cholesterol stones

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5
Q

What are the two types of bile pigment stone?

A

Black

Brown

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6
Q

What causes black pigment gallstones?

A

Haemolytic conditions

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7
Q

What causes brown pigment gallstones?

A

Biliary stasis/infection

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8
Q

What are the Sx of biliary colic?

A 
Severe CONSTANT epigastric/RUQ pain w/ crescendo characteristic
Radiate to back/r shoulder
Nausea/vomiting
Worse after eating/mid-evening
Often wakes patient
Cessation may be spontaneous
Patient systemically well
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9
Q

What are the Sx of acute cholecytistis?

A

Initial features similar to biliary colic
Severe localised RUQ pain w/ guarding/rigidity
Vomiting & systemic upset
-fever
-leukocytosis
Palpable gall bladder
Murphy’s +ve

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10
Q

What are the common tests used to diagnose calculus biliary tract disease?

A 
WBC/inflammatory markers raised
LFTs marginally deranged
Amylase
PT
Abdo USS
MRCP
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11
Q

What are the main presenting conditions caused by gallstones?

A 
Biliary colic/acute cholecystitis
Choledocholithiasis
Mirizzi's syndrome
Gallstone ileus
Ascending cholangitis
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12
Q

What causes biliary colic?

A

Temporary obstruction of cystic duct/common bile duct by gallstone

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13
Q

What causes choledocholithiasis?

A

Stone impaction in common bile duct
Can cause biliary colic/obstructive jaundice
Predisposing to ascending cholangitis/acute pancreatitis

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14
Q

Describe Mirizzi’s syndrome

A

Gallstone impacted in cystic duct/Hartmann’s pouch –> extrinsic compression of common hepatic duct –> obstructive jaundice

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15
Q

Describe gallstone ileus

A

Large gallstone erodes gall bladder lumen –> fistula into adjacent duodenum/ileum –> obstruction

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16
Q

What are the possible presentations of stones in the bile ducts?

A 
Biliary colic
Acute cholecystitis
Chronic cholecystitis
Common bile duct obstruction
Ascending cholangitis
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17
Q

What is Murphy’s sign?

A

Continuous pressure over gall bladder during inhalation will cause patient to catch breath at point of maximum inhalation

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18
Q

What is Courvoisier’s law?

A

If in the presence of jaundice the gallbladder is palpable then the jaundice is unlikely to be due to a stone

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19
Q

What are the most common bacterial infections found in acute cholecystitis?

A

E.coli
Klebisella
Streptococcus

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20
Q

What causes cholecystitis?

A

Obstruction of gall bladder emptying by gallstone leading to gall bladder distention
-2o inflammatory response

21
Q

What is ascending cholangitis?

A

Infection of CBD, usually following cholecodolithiasis

22
Q

How does ascending cholangitis present?

A

Charcot’s Triad:

  • obstructive jaundice
  • fever +/- rigors
  • RUQ pain
23
Q

What is the main complication of ascending cholangitis?

A

Severe sepsis (10% mortality)

24
Q

What is chronic cholecystitis?

A

Repeated episodes of inflammation leads to fibrosis & thickening of gall bladder wall

  • abdo pain
  • discomfort/flatulence after fatty meals
25
Q

What is the most common cause of CBD obstruction?

A

Choledocholithiasis

26
Q

How does Choledocholithiasis present?

A

Obstructive jaundice & biliary colic

  • attacks lasting hrs-days
  • if obstruction not relieved can cause 2o biliary cirrhosis & liver failure
27
Q

How should asymptomatic gallstones be treated?

A

Cholecystectomy if pt at significant risk of complications

  • young pts
  • comorbidities (DM, CKD)
28
Q

How is biliary colic managed?

A 
Admit, bed rest, fluids & analgesia (NBM)
Elective laparoscopic cholecystectomy
   -hot (<72hrs) OR cold (6wks)
Oral bile salts (chenodexocycholic acid)
   -for small, non-calcified stones
29
Q

What are the potential complications of an elective laparoscopic cholecystectomy?

A

Bile leakage/jaundice (ductal injury)
Missed stones in CBD
Intolerance to fatty meals post-op

30
Q

What are T-tubes?

A

Used to drain CBD/remove residual stones post-op

31
Q

How is acute cholecystitis managed?

A 
Admit, bed rest, fluids &amp; analgesia (NBM)
IV Cefuroxime
Elective laparoscopic cholecystectomy
   -hot (<72hrs) OR cold (6wks)
Oral bile salts (chenodexocycholic acid)
   -for small, non-calcified stones
32
Q

What are the most commonly cultured organisms in acute cholecystitis?

A

E. coli
Klebsiella
Streptococcus

33
Q

How is chronic cholecystitis managed?

A

Laparoscopic cholecystectomy w/ cholangiogram

34
Q

How is obstructive jaundice due to gallstones managed?

A

ERCP
- sphincterotomy, remove stones
-give IV vit K before
Elective laparoscopic cholecystectomy

35
Q

How is ascending cholangitis managed?

A

Sepsis six
IV cefuroxime + metronidazole
Emergency ERCP

36
Q

What are the constituents of bile?

A 
Cholesterol
Phospholipids
Bile salts
Water
Conjugated bilirubin
37
Q

What is the function of bile salts?

A

Break up/emulsify fats in GI tract

38
Q

What is the normal flow of bile?

A

Bile flows into gallbladder if sphincter of Oddi closed
-becomes more concentrated
Presence of fatty acids/amino acids in duodenum releases CCK
-gall bladder contracts & sphincter opens
-bile released

39
Q

What is the aetiology of carcinoma of the gall bladder?

A

Uncommon adenocarcinoma
Occurs in the elderly
Associated w/ longstanding gallstones

40
Q

What are the sx of carcinoma of the gall bladder?

A

RUQ pain
N/V
Wt loss
Obstructive jaundice & palpable mass (late sign)

41
Q

How does carcinoma of the gall bladder spread?

A

Direct invasion of liver

Lymphatic spread

42
Q

What are the management options for carcinoma of the gall bladder?

A

Surgical

  • radical cholecystectomy +/- liver resection
  • if found incidentally, often presents too late
43
Q

What is the prognosis for carcinoma of the gall bladder?

A

Survival is short

Often presents too late for surgical management

44
Q

What is a cholangiocarcinoma?

A

Adenocarcinoma arising from epithelium of bile duct/ampulla

-often at confluence of ducts in biliary tree

45
Q

How does cholangiocarcinoma present?

A

Painless progressive jaundice

If arise from intrahepatic ducts presents like HCC

46
Q

What conditions is cholangiocarcinoma associated with?

A

IBD

1o sclerosing cholangitis

47
Q

What is the prognosis of cholangiocarcinoma?

A

Slow growing & metastasise late BUT
Often advanced at presentation
Low long term survival

48
Q

What are the management options for cholangiocarcinoma?

A 
Extra-hepatic/periampullary tumours may be treated by curative resection (Whipple's)
Palliative stenting (ERCP)

CP3 @ UoN - Medicine & Surgery (135 decks)

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