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GI > Biliary Colic + Ascending Cholangitis > Flashcards

Biliary Colic + Ascending Cholangitis Flashcards

1
Q

cause of biliary colic?

A

gallstones passing through biliary tree.

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2
Q

medical term for gallstones?

etymology of this word?

A

cholelithiasis

o Chole – gall
o Lith – stone

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3
Q

what are gallstones made of?

-3

A

 Cholesterol

 Pigment

 Mixed

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4
Q

what are most gallstones made of?

how many gallstones are made of this?

what is the colour if it made of said thing?

A

Cholesterol

80%

yellow

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5
Q

what is within bile naturally?

-3 things

A

cholesterol, bile salts, water

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6
Q

if the colour of the cholelithiasis is black.

what is it made of?

A

pigment

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7
Q

what are the 4f’s?

A

Female
Fat
Fertile
Forty

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8
Q

asides from the 4f’s what are some other risk factors?

-4

A

Diabetes mellitus
Crohn’s disease
Rapid weight loss
HRT + pill – oestrogen

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9
Q

how many cholelithiasis pts are asymptomatic?

%wise

A

80%

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10
Q

why would bariatric surgery be a RF for gallstone formation?

A

eating less – biliary stasis –> gallstones formed

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11
Q

why does the painful biliary colic happen?

A

Stone stuck in cystic duct –> gallbladder contracts against this

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12
Q

which IBD is a RF?

why?

A

Crohn’s

ileum does not reabsorb bile salts –> more cholesterol put into the bile.

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13
Q

which hormone which is often taken in drug form is RF?

why?

A

Oestrogen

↑amount of cholesterol the liver puts in bile

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14
Q

why is sickle cell disease a RF?

which type of cholelithiasis will be made?

A

Haemolysis - ↑bilirubin – pigment gallstones

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15
Q

most common complication?

classic sign for this complication?

A

Acute cholecystitis

+ve Murphy’s sign

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16
Q

which complication of cholelithiasis is a rare type of SBO?

what is the name of the fistula that was made to cause this complication?

A

Gallstone ileus

cholecystoduodenal fistula

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17
Q

if gallstone is stuck in ampulla Vater,

what complication can happen?

A

Acute pancreatitis

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18
Q

which complication can happen that is as infection?

what is the classic triad for this called?

components of the triad?

A

Ascending cholangitis

Charcot’s triad

jaundice, fever, RUQ pain

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19
Q

someone has gall stones.

now has jaundice, pale stools, dark urine.

what complication is this?

where has this gallstone become stuck?

A

Obstructive jaundice

common bile duct

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20
Q

how will the pain be in cholethiasis?

  • where
  • character
  • worse
  • radiation
A

RUQ pain
colicky (crampy)
worse after fatty foods
radiate to shoulder

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21
Q

N&V is common.

true or false?

A

true

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22
Q

1st line Ix?

A

US

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23
Q

pt has cholelithiasis.

has now developed further symptoms and on bloods there is↑↑↑ALP, bilirubin.

what complication is this?

A

obstructive jaundice

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24
Q

pt has cholelithiasis.

has now developed further symptoms and on bloods there is:
↑↑↑amylase
↑↑↑lipase

what complication is this?

A

acute pancreatitis

25
Q

pt has cholelithiasis.

has now developed further symptoms and on bloods there is:
↑CRP

what complication is this?

A

cholecystitis

26
Q

1st line Management?

A

Laparoscopic cholecystectomy (elective)

27
Q

what is the surgery for cholelithiasis called?

etymology of word?

A

cholecystectomy

o Chole - gall
o Cyst - bladder

28
Q

after surgery for cholelithiasis, what is the dietary advice for the pt?

A

no fatty foods

29
Q

when waiting for surgery for cholelithiasis,

what analgesia can be given for moderate pain?
-2

A

paracetamol or diclofenac

30
Q

when waiting for surgery for cholelithiasis,

what analgesia can be given for severe pain?

  • class
  • give two examples
A

opioids

morphine, pethidine

31
Q

which duct comes directly from the gall bladder?

A

cystic duct

32
Q

which duct comes directly from the liver?

A

common hepatic duct

33
Q

the pancreatic duct joins which duct?

which new duct has now been made?

A

common bile duct

ampulla of vater

34
Q

common bile duct is made of which two ducts joining?

A

cystic duct

common hepatic duct

35
Q

which muscular sphincter is at the end of the biliary tree at the opening to the duodenum?

A

sphincter of oddi

36
Q

arterial blood supply to the gall bladder?

- begin with abdominal aorta

A

AA –> coeliac trunk –> common hepatic artery –> hepatic right hepatic artery –> cystic artery

37
Q

venous drainage of the gall bladder?

- end with IVC

A

cystic vein –> portal vein –> hepatic vein –> IVC

38
Q

where is bile made?

A

liver

39
Q

where is bile stored?

A

gall bladder

40
Q

effect of alcohol on sphincter at biliary tree/ duodenum?

name of this sphincter?

what can this cause?

A

contraction

sphincter of oddi

acute pancreatitis

41
Q

artery to the gall bladder?

what is this artery also known as?

A

cystic artery

bachelor artery

42
Q

artery to the cystic duct?

A

cystic artery

43
Q

where is bile reabsorbed?

A

ileum

44
Q

for ascending Cholangitis to even happens what must you have?

what is the biggest cause of said thing?

A

obstruction

gall stones

45
Q

explain pathophysiology of ascending cholangitis?

A

OBSTRUCTION – ↑biliary intraluminal pressure – pushes bacteria up biliary tract – infection

46
Q

in ascending cholangitis where does the bacteria come from?

A

duodenum

47
Q

how does biliary obstruction affect immune system?

A

↓↓anti-bacterial defences

48
Q

name three things that could obstruct the biliary tree and thus cause ascending cholangitis?
-3

A

Gallstones
ERCP
Tumours

49
Q

which triad is associated with ascending cholangitis?

how often is this triad actually seen?
-% range

A

Charcot’s triad

20-50%

50
Q

which triad is associated with ascending cholangitis?

what are the components of the triad?

A

Charcot’s triad

RUQ pain, fever, jaundice

51
Q

what is the most common symptom of ascending cholangitis?

A

Fever

52
Q

what is ascending cholangitis (bascially)?

A

bacterial infection of biliary tree

53
Q

which pentad can occur with ascending cholangitis?

components of this pentad?

what infective emergency complication should you be thinking of if this pentad occurs?

A

Reynold’s pentad

Charcot’s triad + hypotension + confusion

sepsis

54
Q

pt has ascending cholangitis.

1st line Management?

  • group of drugs
  • route
A

IV antibiotics

55
Q

pt has ascending cholangitis.
severely unwell and not responding to the first line medical care.

what surgery can be done for him/her?

  • name of surgery
  • method used
  • elective or urgent
A

biliary decompression
ERCP
urgent

56
Q

pt has ascending cholangitis.

he has responded to the first line medical care and is clinically stable.

what is next step in management?

A

elective ERCP

57
Q

diclofenac drug class?

moa?

A

NSAIDs

inhibits cyclooxygenase-1 and -2 so stops PG formation

58
Q

usual bacteria that causes ascending cholangitis?

A

E.Coli

GI (25 decks)

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