Biliary Flashcards
What % of gallstone disease is symptomatic?
1-4%
What forms bile?
cholesterol, phospholipids, bile pigments
What are bile pigments?
products of haemoglobin metabolism
Where is bile produced?
in hepatocytes in the liver as bile salts are conjugated there
How does bile travel from the liver to gallbladder?
common hepatic duct
How does bile travel from the gallbladder?
cystic duct then common bile duct
What are risks for gallstone formation?
5FS - fat, female, forties, fertile, family
What is biliary colic?
when the gallbladder neck is impacted by a gallstone so contraction causes pain but there is no inflammation
How does biliary colic present?
sudden, dull, colicky RUQ pain
can radiate to epigastrium/back
worse after fatty meal
assoc N+V
What is acute cholecystitis?
an inflamed gallbladder
How does acute cholecystitis present?
constant RUQ pain
fever
murphys sign
What does RUQ pain + guarding suggest?
perforated gallbladder
What LFT may indicate ductal obstruction?
raised ALP
What imaging is first line in gallstones?
transabdo USS
What should be looked for gallstones on US?
- presence of gallstones
- gallbladder wall thickness
- bile duct dilatation
What does a thick gallbladder wall suggest?
inflammation
What is the goldstandard investigation for gallstones?
MRCP
How should biliary colic be managed?
analgesia + lifestyle advice
offer elective laparascopic cholecytstecomy
How should acute cholecystitis be managed?
IV antibiotics
analgesia + antiemetics
laparascopic cholecystectomy within 1wk
What is Mirizzi syndrome?
stone in hartmann’s pouch or cystic duct compresses common hepatic duct causing obstructive jaundice
What is ascending cholangitis?
an infection of the biliary tree caused by biliary outflow obstruction
How does ascending cholangitis present?
charcots triad: RUQ pain, fever, jaundice
How should ascending cholangitis be investigated and managed?
ERCP
ABCDE and Sepsis 6
