biliary

Question 1

what is cholestasis

Answer 1

blocked bile flow

Question 2

what is cholelithiasis

Answer 2

gallstones

Question 3

cholangitis

Answer 3

inflamm of bile ducts

Question 4

cholecystitis

Answer 4

inflamm of gallbladder

Question 5

what is biliary colic

Answer 5

RUQ from gallstones in bile ducts

Question 6

what 3 ducts form the common bile duct

Answer 6

right and left hepatic duct (from liver) + cystic duct (from gallbladder)

Question 7

what forms the apulla of vater

Answer 7

common bile duct and pancreatic duct

Question 8

what controls flow of bile and pancreatic secretions into duodenum

Answer 8

sphincter of Oddi

Question 9

who commonly gets gallstones

Answer 9

fat fair female 40

Question 10

what conditions are RF for gallstones

Answer 10

Crohns // DM // rapid weight loss

Question 11

biliary colic presentation

Answer 11

colicky RUQ pain postprandially + worse fatty meal //no fever and normal LFTs + normal inflamm

Question 12

when do gallstones cause symptoms (anatomically)

Answer 12

in CBD // in gallbladder alone they are common and do not require treatment

Question 13

invx of gallstones complications

Answer 13

abso USS and abnormal LFT’s (usually ALT) –> MCRP (if in CBD)

Question 14

how are gallstones managed

Answer 14

(ECRP if gallstones in CBD not causing complications) —> lap chole (gold standard)

Question 15

RF of ECRP (4)

Answer 15

bleeding // duodenal perforation // cholangitis // pancreatitis

Question 16

common complications of gallstones

Answer 16

acute cholecystitis // acute cholangitis // obstructive jaundice // pancreatitis

Question 17

what is the most common cause of acute cholecystitis

Answer 17

gallstones (90%)

Question 18

features of acute cholecystitis

Answer 18

RUQ and right shoulder tip pain // systemically unwell // murphy’s sign (inspiratory arrest on RUQ) // normal LFT’s

Question 19

what would derranged LFT’s in acute cholecystitis indicate

Answer 19

Mirizzi syndrome –> compression of CBD (normally normal LFTs)

Question 20

1st and 2nd line invx acute cholecystitis

Answer 20

1st = USS // 2nd = HIDA scan

Question 21

mx acute cholecystitis

Answer 21

cholecystectomy (removal) within 1 week + IV abx

Question 22

what is ascending cholangitis

Answer 22

bacterial infection of biliary tree secondary to gallstones

Question 23

organism in ascending cholangitis

Answer 23

E coli

Question 24

what triad is seen in ascending cholangitis

Answer 24

charcots: fever + RUQ pain + jaundice

Question 25

what pentad is seen in ascending cholangitis

Answer 25

Reynolds: hypotension + confusion + charcots triad

Question 26

invx ascending cholangitis

Answer 26

USS

Question 27

mx ascending cholangitis

Answer 27

IV abx and ECRP

Question 28

what is gallstones ileus

Answer 28

gallstone –> fistula between gallbladder and duodenum +/- SBO

Question 29

gallbladder abscess symptoms

Answer 29

prodromal illness // RUQ // swinging fever

Question 30

what is primary sclerosing cholangitis

Answer 30

inflamm and fibrosis of intra and extra hepatic bile ducts

Question 31

what condition is assoc with primary sclerosing cholangitis (PSC)

Answer 31

UC!!! (crohns + HIV)

Question 32

symptoms PSC

Answer 32

cholestasis (jaundice, itch, raised bili + ALP) // RUQ pain // fatigue

Question 33

invx in PSC (3)

Answer 33

ECRP or MCRP // pANCA // liver biopsy

Question 34

what disease is the main risk factor for cholangiocarcinoma (bile duct cancer)

Answer 34

Primary sclerosing cholangitis

Question 35

what tumour marker is raised in cholangiocarcinoma

Answer 35

Ca 199

Question 36

symptoms of cholangiocarcinoma

Answer 36

biliary colic // anorexia // jaundice // mass in RUQ (courvoisier sign) // periumbilical lymph + left supraclavicular lymph

Question 37

what nodes may be up in cholangiocarcinoma

Answer 37

periumbilica (sister mary joseph) // left supraC (virchows)