Biliary Colic and Cholecystitis Flashcards
What is bile formed from?
Cholesterol, phospholipid and bile pigments
Where is bile stored?
gallbladder
Why do gallstones form?
supersaturation of the bile
What are the three main types of gallstones?
cholesterol stones, pigment stones and mixed stones
Who has pigment stones?
People with haemolytic anaemia
What are the risk factors for gallstones?
Fat, Female, Fertile, Forty and Family history, also oral contraceptives, haemolytic anaemia, malabsorption
What is biliary colic?
When the gallbladder neck becomes impacted by a stone, there is no inflammatory response but the occluded neck will cause pain
what is pain like in biliary colic?
sudden, dull, colicky, right upper quadrant, radiates to the back and epigastrium, after eating fatty foods due to CCK, nausea and vomiting
What are the symptoms in acute cholecystitis?
pain like biliary colic but constant due to inflammation, so will have derangement of liver function tests, jaundice, hepatomegaly, peritonitis, positive murphys sign
What is Murphys sign?
when applying pressure in the RUQ, patient inspires and if there is a halt in inspiration due to pain this is an inflamed gallbladder
What is differential diagnosis for gallstones?
gastro-oesophageal reflux disease, Peptic ulcer disease, acute pancreatitis, IBD
What blood tests would you do for gallstones?
FBC, CRP, U and E for dehydration, LFTs- raised ALP, amylase to check for pancreatitis
What imaging would you do for gallstones?
Trans-abdominal ultrasound, look for presence of gallstones or sludge, gallbladder wall thickness, bile duct dilatation, MRCP
What is the management for Biliary Colic?
analgesia, antibiotic, lifestyle factors, elective cholecystectomy
What is the management for acute cholecystitis?
IV antibiotics, analgesia, antiemetics, laparasopic cholecystectomy
