Biliary Flashcards
What is the Murphy’s sign?
(1. ) Test where you palpate the gallbladder area medial to the midclavicular line while the patient is lying supine.
(2. ) Ask patient to inhale deeply, which expands the lungs and pushes the gallbladder against the examiner’s fingertips.
(3. ) The Murphy signs is considered positive if the patient abruptly ceases inhaling due to pain.
(4. ) A positive Murphy sign can be seen with acute cholecystitis.
(5. ) Remember that the absence of a positive Murphy sign does not rule out cholecystitis
What is Charcot’s Triad?
(1. ) Charcot’s triad: all three symptoms are observed in about 50–70 % of patients:
(a. ) RUQ pain (biliary colic)
(b. ) fluctuating jaundice
(c. ) swinging pyrexia (usually with rigors)
What’s Reynolds’ pentad?
(1. ) Charcot’s triad PLUS hypotension and a decreased level of consciousness
(2. ) Can be observed in more severe forms of acute cholangitis in spetic shock
Define Cholelithiasis
formation of gallstones
Define Cholecystitis
inflammation of the gallbladder usually due to an obstruction
Define Choledocholithiasis
gallstones within the common bile duct
Define Cholangitis
Inflammation of bile ducts, It can be thought of as —> Choledocholithiasis (CBD obstruction) + infection
Normal physiology vs Cholethiasis
Normal Physiology
(1. ) GB stores bile and is released when digesting fatty foods, this travels to the duodenum.
(2. ) Bile contains phospholipids, proteins, bilirubin, bile salts and acids, cholesterol.
(3. ) Bile helps with digestion. It breaks down fats into fatty acids, which can be taken into the body by the digestive tract.
Gallstone
(1. ) Gallstones are solid deposit that forms within the gallbladder
(2. ) Gallstones may cause no signs or symptoms. It is until the stone lodges in a duct and causes a blockage that Sx will show.
RF for Cholethiasis
‘the four F’s’ for Gallstones.
Fat, Female, Fertile, Forty
What are two types of gallstones?
(1. ) Cholesterol Stones
- yellow, chalk white
- Not visible on xray usually
- Normally = cholesterol is rendered soluble in bile by aggregation with bile salts
- Causes:
a. high saturation of cholesterol in bile
b. Not enough bile salts/acid
c. Gallbladder stasis so cholesterol is separated and precipitated
(2. ) Bilirubin or pigmented stones
- dark brown, small
- made of bilirubin and calcium phosphate
- visible on xray
- Causes:
a. Excess bilirubin may arise due to chronic hemolytic anaemia
b. Bacterial or Parasitic infection of the biliary tract where bacteria to ascend from duodenum to gallbladder and alter the bilirubin which in turn combines with calcium to form pigment
Signs and Symptoms of Cholethiasis
(1. ) Asymptomatic (80%)
(2. ) Biliary colic/RUQ pain
- Severe abdominal pain can arise when gallbladder get lodged in bile duct
(3. ) Worsens with fatty food
Investigations of Cholethiasis
- Ultrasound - diagnostic tool, ‘acoustic shadowing’ can be seen
- CT or MRCP - used for detecting any complications
Treatment and Management of Cholethiasis
- Asymptomatic = No treatment
- Symptomatic =
- Laparoscopic cholecystectomy
- Avoid tigger food and drink until GB is removed
- NSAID + anti-spasmodic if needed - After cholecystectomy
- Advised to follow a low-fat diet for several weeks before surgery, but this doesn’t need to be continued afterwards.
- No special diets are needed
Pathophysiology of Cholecystitis
Inflammation of cystic duct and gallbladder due to gallstone being lodged in the cystic duct
Signs and symptoms of Acute Cholecystitis
(1. ) RUQ, epigastrium, right shoulder - positive murphy sign
(2. ) Constant pain
(3. ) Fever
(4. ) Jaundice in <10% of cases
