Bilary

Question 1

What are the RFs for cholesterol gallstones (8)

Answer 1

Age
Female
Obesity / high fat diet
Pregnancy / multiparity / OCP
Rapid wt loss
Cirrhosis
Ileal resection / Crohn's
DM

Question 2

What are the 2 diff types of gallstones

Answer 2

Cholesterol

Bile pigment stones

Question 3

What is choledocholithiasis?

How conditions may it present as? (4)

Answer 3

= stone in common bile duct

Temporary biliary colic
Prolonged painful obstructive jaundice
Ascending cholangitis (± liver abscesses)
Acute pancreatitis

Question 4

What is Charcot’s triad?

Answer 4

Ascending cholangitis:
RUQ pain
Jaundice
Fever ± rigors

Question 5

What is Mirizzi’s syndrome?

How is it differentiated from other gallstone conditions?

Answer 5

In CD / Hartmann’s pouch
But ext compresses on CHD
Obstructive jaundice w/o CD/CBD dilation on USS

Question 6

What is gallstone ileus?
How does it present
How is it Dx

Answer 6

Large gallstone forms fistula to duodenum

SBO: at terminal ileum (narrow segment)

AXR: SBO / Gallstone / Pneumobilia

Question 7

What Ix are done in ?Gallstone disease? (4+3)

Answer 7

Bloods:
WCC/CRP
LFTs
Amylase / Lipase
Clotting (PT time, pre-intervention)

Imaging:
USS (1st line)
MRCP
± AXR/CT

Question 8

Describe the management of Biliary colic

Answer 8

Bed rest (admit)
Analgesia (opiates)
Fluids + NBM
Elective lap-chole (72hrs / 6wks)

Question 9

Describe the management of acute cholecystitis

Answer 9

Bed rest (admit)
Analgesia 
Fluids + NBM
Elective lap-chole (72hrs/6wks)
\+ IV cefuroxime if ?infection

Question 10

Describe the management of chronic cholecystitis

Answer 10

Elective lap-chole

Cholangiogram (remove any CBD stones ERCP)

Question 11

Describe the management of ascending cholangitis (3)

Answer 11

Sepsis 6
IV cef + met
Emergency ERCP