bile stuff Flashcards
risk factors for biliary colic
age female family history diabetes obesity impaired gall bladder emptying
what can cause obstructive biliary colic?
stones
cancer
parasites
symptoms of biliary colic
recurrent pain in epigastric region ±right upper quadrant
pain radiating to right shoulder (subscapular)
pain and vomiting associated with fatty food
complications of biliary colic
cholecystitis
diagnosis of biliary colic
bloods (LFT, ALP, bilirubin)
abdominal US
treatment of biliary colic
analgesia
elective cholecystectomy
antibiotics if needed
pathology of cholecystitis
inflammation of gall bladder, usually following blockage of cystic duct
signs of acute cholecystitis
Murphy's sign local peritoneum palpable mass pain vomiting fever
signs of chronic cholecystitis
abdominal distension
flatulence
fat intolerance
complications of cholecystitis
gallstone pancreatitis
common bile duct stones
diagnosis of cholecystitis
bloods
US
treatment of cholecystitis
cholecystectomy
risk factors for gall stones
female, forty, fat, fair
birth control pills pregnancy family history obesity diabetes liver disease rapid weight loss
symptoms of gall stones
biliary colic (cramping pain in RUQ)
complications of gall stones
mucocoele cholecystitis choledochithiasis cholangitis pancreatitis gallstone ileus
diagnosis of gall stones
US
treatment of gallstones
surgery
what percentage of gallstones are made of cholesterol?
75%
what percentage of gallstones are made of bile pigment?
10%
what is cholangitis?
inflammation of bile vessels
what is ductopaenia?
when more than 50% of bile ducts are destroyed
pathology of primary biliary cholangitis
macrophages form granuloma and lymphocytes attack bile duct
chronic inflammation and destruction of interloper bile ducts
cholestasis –> fibrosis –> cirrhosis
signs of cholangitis
jaundice epigastric/RUQ tenderness and guarding hypotension confusion fever rigors pruritis dark urine and pale stool
what is diagnostic of cholangitis?
Charcot’s triad:
jaundice
RUQ pain
fever + rigors
investigations for cholangitis
bloods - FBC, CRP, LFT
imaging - USS, ERCP, MRCP
treatment of cholangitis
IV fluid and antibiotics
analgesia
relieve obstruction - ERCP
cholecystectomy
risk factors for primary biliary cholangitis
female (9:1)
signs of primary biliary cholangitis
skin pigmentation xanthelasma xanthomas hepatosplenomegaly jaundice pruritis
complications of primary biliary cholangitis
strictures (associated with IBD)
cholangiocarcinoma
ductopaenia
fibrosis
diagnosis of primary biliary cholangitis
blood tests
imaging
biopsy
treatment of primary biliary cholangitis
ursodeoxycholic acid colestyramine (for the itch) treat complications of cirrhosis vitamin supplements consider liver transplant
what are the 3 As of primary biliary cholangitis?
Al
AMA +ve
ALP up
