Biliary Colic + Ascending Cholangitis Flashcards
cause of biliary colic?
gallstones passing through biliary tree.
medical term for gallstones?
etymology of this word?
cholelithiasis
o Chole – gall
o Lith – stone
what are gallstones made of?
-3
Cholesterol
Pigment
Mixed
what are most gallstones made of?
how many gallstones are made of this?
what is the colour if it made of said thing?
Cholesterol
80%
yellow
what is within bile naturally?
-3 things
cholesterol, bile salts, water
if the colour of the cholelithiasis is black.
what is it made of?
pigment
what are the 4f’s?
Female
Fat
Fertile
Forty
asides from the 4f’s what are some other risk factors?
-4
Diabetes mellitus
Crohn’s disease
Rapid weight loss
HRT + pill – oestrogen
how many cholelithiasis pts are asymptomatic?
%wise
80%
why would bariatric surgery be a RF for gallstone formation?
eating less – biliary stasis –> gallstones formed
why does the painful biliary colic happen?
Stone stuck in cystic duct –> gallbladder contracts against this
which IBD is a RF?
why?
Crohn’s
ileum does not reabsorb bile salts –> more cholesterol put into the bile.
which hormone which is often taken in drug form is RF?
why?
Oestrogen
↑amount of cholesterol the liver puts in bile
why is sickle cell disease a RF?
which type of cholelithiasis will be made?
Haemolysis - ↑bilirubin – pigment gallstones
most common complication?
classic sign for this complication?
Acute cholecystitis
+ve Murphy’s sign
which complication of cholelithiasis is a rare type of SBO?
what is the name of the fistula that was made to cause this complication?
Gallstone ileus
cholecystoduodenal fistula
if gallstone is stuck in ampulla Vater,
what complication can happen?
Acute pancreatitis
which complication can happen that is as infection?
what is the classic triad for this called?
components of the triad?
Ascending cholangitis
Charcot’s triad
jaundice, fever, RUQ pain
someone has gall stones.
now has jaundice, pale stools, dark urine.
what complication is this?
where has this gallstone become stuck?
Obstructive jaundice
common bile duct
how will the pain be in cholethiasis?
- where
- character
- worse
- radiation
RUQ pain
colicky (crampy)
worse after fatty foods
radiate to shoulder
N&V is common.
true or false?
true
1st line Ix?
US
pt has cholelithiasis.
has now developed further symptoms and on bloods there is↑↑↑ALP, bilirubin.
what complication is this?
obstructive jaundice
pt has cholelithiasis.
has now developed further symptoms and on bloods there is:
↑↑↑amylase
↑↑↑lipase
what complication is this?
acute pancreatitis
pt has cholelithiasis.
has now developed further symptoms and on bloods there is:
↑CRP
what complication is this?
cholecystitis
1st line Management?
Laparoscopic cholecystectomy (elective)
what is the surgery for cholelithiasis called?
etymology of word?
cholecystectomy
o Chole - gall
o Cyst - bladder
after surgery for cholelithiasis, what is the dietary advice for the pt?
no fatty foods
when waiting for surgery for cholelithiasis,
what analgesia can be given for moderate pain?
-2
paracetamol or diclofenac
when waiting for surgery for cholelithiasis,
what analgesia can be given for severe pain?
- class
- give two examples
opioids
morphine, pethidine
which duct comes directly from the gall bladder?
cystic duct
which duct comes directly from the liver?
common hepatic duct
the pancreatic duct joins which duct?
which new duct has now been made?
common bile duct
ampulla of vater
common bile duct is made of which two ducts joining?
cystic duct
common hepatic duct
which muscular sphincter is at the end of the biliary tree at the opening to the duodenum?
sphincter of oddi
arterial blood supply to the gall bladder?
- begin with abdominal aorta
AA –> coeliac trunk –> common hepatic artery –> hepatic right hepatic artery –> cystic artery
venous drainage of the gall bladder?
- end with IVC
cystic vein –> portal vein –> hepatic vein –> IVC
where is bile made?
liver
where is bile stored?
gall bladder
effect of alcohol on sphincter at biliary tree/ duodenum?
name of this sphincter?
what can this cause?
contraction
sphincter of oddi
acute pancreatitis
artery to the gall bladder?
what is this artery also known as?
cystic artery
bachelor artery
artery to the cystic duct?
cystic artery
where is bile reabsorbed?
ileum
for ascending Cholangitis to even happens what must you have?
what is the biggest cause of said thing?
obstruction
gall stones
explain pathophysiology of ascending cholangitis?
OBSTRUCTION – ↑biliary intraluminal pressure – pushes bacteria up biliary tract – infection
in ascending cholangitis where does the bacteria come from?
duodenum
how does biliary obstruction affect immune system?
↓↓anti-bacterial defences
name three things that could obstruct the biliary tree and thus cause ascending cholangitis?
-3
Gallstones
ERCP
Tumours
which triad is associated with ascending cholangitis?
how often is this triad actually seen?
-% range
Charcot’s triad
20-50%
which triad is associated with ascending cholangitis?
what are the components of the triad?
Charcot’s triad
RUQ pain, fever, jaundice
what is the most common symptom of ascending cholangitis?
Fever
what is ascending cholangitis (bascially)?
bacterial infection of biliary tree
which pentad can occur with ascending cholangitis?
components of this pentad?
what infective emergency complication should you be thinking of if this pentad occurs?
Reynold’s pentad
Charcot’s triad + hypotension + confusion
sepsis
pt has ascending cholangitis.
1st line Management?
- group of drugs
- route
IV antibiotics
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
biliary decompression
ERCP
urgent
pt has ascending cholangitis.
he has responded to the first line medical care and is clinically stable.
what is next step in management?
elective ERCP
diclofenac drug class?
moa?
NSAIDs
inhibits cyclooxygenase-1 and -2 so stops PG formation
usual bacteria that causes ascending cholangitis?
E.Coli
