bile stuff

Question 1

risk factors for biliary colic

Answer 1

age
female
family history
diabetes
obesity
impaired gall bladder emptying

Question 2

what can cause obstructive biliary colic?

Answer 2

stones
cancer
parasites

Question 3

symptoms of biliary colic

Answer 3

recurrent pain in epigastric region ±right upper quadrant
pain radiating to right shoulder (subscapular)
pain and vomiting associated with fatty food

Question 4

complications of biliary colic

Answer 4

cholecystitis

Question 5

diagnosis of biliary colic

Answer 5

bloods (LFT, ALP, bilirubin)

abdominal US

Question 6

treatment of biliary colic

Answer 6

analgesia
elective cholecystectomy
antibiotics if needed

Question 7

pathology of cholecystitis

Answer 7

inflammation of gall bladder, usually following blockage of cystic duct

Question 8

signs of acute cholecystitis

Answer 8

Murphy's sign
local peritoneum 
palpable mass
pain 
vomiting 
fever

Question 9

signs of chronic cholecystitis

Answer 9

abdominal distension
flatulence
fat intolerance

Question 10

complications of cholecystitis

Answer 10

gallstone pancreatitis

common bile duct stones

Question 11

diagnosis of cholecystitis

Answer 11

bloods

US

Question 12

treatment of cholecystitis

Answer 12

cholecystectomy

Question 13

risk factors for gall stones

Answer 13

female, forty, fat, fair

birth control pills
pregnancy 
family history
obesity
diabetes
liver disease
rapid weight loss

Question 14

symptoms of gall stones

Answer 14

biliary colic (cramping pain in RUQ)

Question 15

complications of gall stones

Answer 15

mucocoele
cholecystitis
choledochithiasis
cholangitis
pancreatitis
gallstone ileus

Question 16

diagnosis of gall stones

Answer 16

US

Question 17

treatment of gallstones

Answer 17

surgery

Question 18

what percentage of gallstones are made of cholesterol?

Answer 18

75%

Question 19

what percentage of gallstones are made of bile pigment?

Answer 19

10%

Question 20

what is cholangitis?

Answer 20

inflammation of bile vessels

Question 21

what is ductopaenia?

Answer 21

when more than 50% of bile ducts are destroyed

Question 22

pathology of primary biliary cholangitis

Answer 22

macrophages form granuloma and lymphocytes attack bile duct

chronic inflammation and destruction of interloper bile ducts
cholestasis –> fibrosis –> cirrhosis

Question 23

signs of cholangitis

Answer 23

jaundice
epigastric/RUQ tenderness and guarding
hypotension 
confusion
fever
rigors
pruritis
dark urine and pale stool

Question 24

what is diagnostic of cholangitis?

Answer 24

Charcot’s triad:
jaundice
RUQ pain
fever + rigors

Question 25

investigations for cholangitis

Answer 25

bloods - FBC, CRP, LFT

imaging - USS, ERCP, MRCP

Question 26

treatment of cholangitis

Answer 26

IV fluid and antibiotics
analgesia
relieve obstruction - ERCP
cholecystectomy

Question 27

risk factors for primary biliary cholangitis

Answer 27

female (9:1)

Question 28

signs of primary biliary cholangitis

Answer 28

skin pigmentation 
xanthelasma
xanthomas
hepatosplenomegaly
jaundice
pruritis

Question 29

complications of primary biliary cholangitis

Answer 29

strictures (associated with IBD)
cholangiocarcinoma
ductopaenia
fibrosis

Question 30

diagnosis of primary biliary cholangitis

Answer 30

blood tests
imaging
biopsy

Question 31

treatment of primary biliary cholangitis

Answer 31

ursodeoxycholic acid 
colestyramine (for the itch)
treat complications of cirrhosis
vitamin supplements
consider liver transplant

Question 32

what are the 3 As of primary biliary cholangitis?

Answer 32

Al
AMA +ve
ALP up