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NMF: General Surgery > Biliary > Flashcards

Biliary Flashcards

1
Q

What % of gallstone disease is symptomatic?

A

1-4%

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2
Q

What forms bile?

A

cholesterol, phospholipids, bile pigments

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3
Q

What are bile pigments?

A

products of haemoglobin metabolism

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4
Q

Where is bile produced?

A

in hepatocytes in the liver as bile salts are conjugated there

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5
Q

How does bile travel from the liver to gallbladder?

A

common hepatic duct

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6
Q

How does bile travel from the gallbladder?

A

cystic duct then common bile duct

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7
Q

What are risks for gallstone formation?

A

5FS - fat, female, forties, fertile, family

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8
Q

What is biliary colic?

A

when the gallbladder neck is impacted by a gallstone so contraction causes pain but there is no inflammation

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9
Q

How does biliary colic present?

A

sudden, dull, colicky RUQ pain
can radiate to epigastrium/back
worse after fatty meal
assoc N+V

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10
Q

What is acute cholecystitis?

A

an inflamed gallbladder

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11
Q

How does acute cholecystitis present?

A

constant RUQ pain
fever
murphys sign

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12
Q

What does RUQ pain + guarding suggest?

A

perforated gallbladder

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13
Q

What LFT may indicate ductal obstruction?

A

raised ALP

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14
Q

What imaging is first line in gallstones?

A

transabdo USS

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15
Q

What should be looked for gallstones on US?

A
  1. presence of gallstones
  2. gallbladder wall thickness
  3. bile duct dilatation
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16
Q

What does a thick gallbladder wall suggest?

A

inflammation

17
Q

What is the goldstandard investigation for gallstones?

A

MRCP

18
Q

How should biliary colic be managed?

A

analgesia + lifestyle advice

offer elective laparascopic cholecytstecomy

19
Q

How should acute cholecystitis be managed?

A

IV antibiotics
analgesia + antiemetics
laparascopic cholecystectomy within 1wk

20
Q

What is Mirizzi syndrome?

A

stone in hartmann’s pouch or cystic duct compresses common hepatic duct causing obstructive jaundice

21
Q

What is ascending cholangitis?

A

an infection of the biliary tree caused by biliary outflow obstruction

22
Q

How does ascending cholangitis present?

A

charcots triad: RUQ pain, fever, jaundice

23
Q

How should ascending cholangitis be investigated and managed?

A

ERCP

ABCDE and Sepsis 6

NMF: General Surgery (8 decks)

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