biliary Flashcards
what is cholestasis
blocked bile flow
what is cholelithiasis
gallstones
cholangitis
inflamm of bile ducts
cholecystitis
inflamm of gallbladder
what is biliary colic
RUQ from gallstones in bile ducts
what 3 ducts form the common bile duct
right and left hepatic duct (from liver) + cystic duct (from gallbladder)
what forms the apulla of vater
common bile duct and pancreatic duct
what controls flow of bile and pancreatic secretions into duodenum
sphincter of Oddi
who commonly gets gallstones
fat fair female 40
what conditions are RF for gallstones
Crohns // DM // rapid weight loss
biliary colic presentation
colicky RUQ pain postprandially + worse fatty meal //no fever and normal LFTs + normal inflamm
when do gallstones cause symptoms (anatomically)
in CBD // in gallbladder alone they are common and do not require treatment
invx of gallstones complications
abso USS and abnormal LFT’s (usually ALT) –> MCRP (if in CBD)
how are gallstones managed
(ECRP if gallstones in CBD not causing complications) —> lap chole (gold standard)
RF of ECRP (4)
bleeding // duodenal perforation // cholangitis // pancreatitis
common complications of gallstones
acute cholecystitis // acute cholangitis // obstructive jaundice // pancreatitis
what is the most common cause of acute cholecystitis
gallstones (90%)
features of acute cholecystitis
RUQ and right shoulder tip pain // systemically unwell // murphy’s sign (inspiratory arrest on RUQ) // normal LFT’s
what would derranged LFT’s in acute cholecystitis indicate
Mirizzi syndrome –> compression of CBD (normally normal LFTs)
1st and 2nd line invx acute cholecystitis
1st = USS // 2nd = HIDA scan
mx acute cholecystitis
cholecystectomy (removal) within 1 week + IV abx
what is ascending cholangitis
bacterial infection of biliary tree secondary to gallstones
organism in ascending cholangitis
E coli
what triad is seen in ascending cholangitis
charcots: fever + RUQ pain + jaundice
what pentad is seen in ascending cholangitis
Reynolds: hypotension + confusion + charcots triad
invx ascending cholangitis
USS
mx ascending cholangitis
IV abx and ECRP
what is gallstones ileus
gallstone –> fistula between gallbladder and duodenum +/- SBO
gallbladder abscess symptoms
prodromal illness // RUQ // swinging fever
what is primary sclerosing cholangitis
inflamm and fibrosis of intra and extra hepatic bile ducts
what condition is assoc with primary sclerosing cholangitis (PSC)
UC!!! (crohns + HIV)
symptoms PSC
cholestasis (jaundice, itch, raised bili + ALP) // RUQ pain // fatigue
invx in PSC (3)
ECRP or MCRP // pANCA // liver biopsy
what disease is the main risk factor for cholangiocarcinoma (bile duct cancer)
Primary sclerosing cholangitis
what tumour marker is raised in cholangiocarcinoma
Ca 199
symptoms of cholangiocarcinoma
biliary colic // anorexia // jaundice // mass in RUQ (courvoisier sign) // periumbilical lymph + left supraclavicular lymph
what nodes may be up in cholangiocarcinoma
periumbilica (sister mary joseph) // left supraC (virchows)
