BILAIRY COLIC

Question 1

WHAT IS BILE FORMED FROM AND WHERE IT IS STORED?

Answer 1

• formed from cholesterol, phospholipids and bile pigments

- stored in gall bladder before passing into duodenum following gall bladder stimulation

Question 2

HOW ARE GALLSTONES FORMED?

Answer 2

• increased cholesterol, decreased bile salts and biliary stasis

Question 3

WHAT IS BILIARY COLIC?

Answer 3

• gallstone temporarily blocking cystic duct (neck of gall bladder) leading to sudden RUQ pain.

Question 4

WHAT CAUSES THE PAIN IN A BILAIRY COLIC?

Answer 4

• contraction of gall bladder against occluded neck leads to pain

Question 5

WHAT ARE THE RISK FACTORS OF BILAIRY COLIC?

Answer 5

1) fat (obese, high cholesterol)
2) female
3) fertile
4) forty

Question 6

WHAT ARE THE CLINICAL FEATURES OF BILAIRY COLIC?

Answer 6

1) RUQ pain that is colicky, sudden, dull, last 15 min to a few hours, may radiate to right shoulder.
2) Worse postprandial (especially after fatty foods)
3) nausea
4) vomiting

Question 7

WHAT ARE THE LABORATORY INVESTIGATIONS FOR A BILAIRY COLIC?

Answer 7

1) Blood test- FBC (normal in simple biliary colic, elevated WCC if there is pancreatitis or cholecystitis), U+E’s (dehydration), LFTS (raised ALP), amylase (pancreatitis)
2) Urinalysis - exclude renal pathology
3) Pregnancy test

Question 8

WHAT ARE THE IMAGING INVESTIGATIONS FOR BILIARY COLIC?

Answer 8

1) Transabdominal ultrasound - 1st line for gallstone pathology
if inconclusive then
2) MRCP (magnetic resonance cholangiopancreatography)

Question 9

WHAT IS THE INITIAL MANAGEMENT FOR A BILIARY COLIC?

Answer 9

1) analgesia
2) PRN opioids
3) antiemetic

Question 10

WHAT IS THE DEFINTIVE MANAGEMENT FOR A BILIARY COLIC?

Answer 10

• Elective cholecystectomy offered within 6 weeks of 1st presentation

Question 11

WHAT ARE THE DIFFERENTIAL DIAGNOSIS FOR A BILAIRY COLIC?

Answer 11

• Acute pancreatitis
• Ascending cholangitis
• GORD
• Peptic ulcer disease

Question 12

WHAT IS THE LIFESTYLE ADVICE FOR BILIARY COLIC/

Answer 12

1) low fat diet
2) weight loss
3) increase exercise

Question 13

IF THERE IS NO IMPROVEMENT WITH ANALGESIA WHAT OTHER PATHOLOGY SHOULD BE CONSIDERED?

Answer 13

• cholecystitis

Question 14

WHY IS ELECTIVE CHOLECYSTECTOMY OFFERED FOR 1ST RPESENTATION OF BILIARY COLIC?

Answer 14

• high chance of recurrence

- chance of developing cholecystitis or acute pancreatitis

Question 15

WHAT IS MRCP?

Answer 15

• magnetic resonance cholangiopancreatography
• produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.