Biliary disease

Question 1

Biliary colic

Answer 1

RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common.

Question 2

Cholethiasis risk factors

Answer 2

Fat, fair, female (oestrogen) , fourty

Question 3

Biliary colic Tx

Answer 3

NSAID, such as diclofenac or indometacin,
with an anti-spasmodic eg hycosine if needed.
Paracetamol might be enough

Question 4

Cholecystitis

Answer 4

Inflammation of the gallbladder + fever +tenderness RUQ

Question 5

Acute cholecystitis pathophysiology

Answer 5

complete cystic duct obstruction usually due to an impacted gallstone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall.

Question 6

acalculous cholecystitis

Answer 6

Gallbladder inflammation in absence of stones, 10% of cases
in immunosuppressed patients it may develop secondary to Cryptosporidium or cytomegalovirus

Question 7

Acute cholecystitis clinical presentation

Answer 7

RUQ pain
may have fever
pain may radiate to back or right shoulder

Question 8

Murphy sign

Answer 8

inspiratory arrest upon palpation of the right upper quadrant
Gallbladder will move downwards under your hand and cause pain because the inflamed gallbladder irritates the parietal peritoneum

Question 9

Boas sign

Answer 9

hyperaesthesia felt by the patient to light touch in the right lower scapular region or the right upper quadrant of the abdomen.

Question 10

Acute cholecystitis Tx

Answer 10

Early laparoscopic cholecystectomy (to be carried out within 1 week of diagnosis)

Question 11

Gall bladder empyema

Answer 11

Infected tissue and pus in gall bladder
commonly caused by Ecoli

Question 12

Choledocholithiasis

Answer 12

gallstone(s) in the bile duct

Question 13

Choledocholithiasis clinical presentation

Answer 13

pain + jaundice, NO fever

Question 14

Acute cholangitis

Answer 14

Infection and obstruction of the biliary system

Question 15

Causes of infection in ascending cholangitis

Answer 15

Escherichia coli is the most common causative agent for ascending cholangitis and then it is followed by Klebsiella

Question 16

Charcot pentad

Answer 16

Fever (rigors are common)
Jaundice
RUQ pain

hypotension
altered mental status

(acute cholangitis)

Question 17

Acute cholangitis Tx

Answer 17

IV broad spectrum Abx
supportive measures: o2, Fluids, May need electrolyte
Endoscopic retrograde cholangiopancreatography (ERCP)

Question 18

primary biliary cirrhosis/cholangitis

Answer 18

All the Ms
IgM
Middle aged female
AMA

Question 19

Primary sclerosing cholangitis iX

Answer 19

MRCP
showing multiple biliary strictures giving a ‘beaded’ appearance
p-ANCA may be positive

Question 20

Features of Primary sclerosing cholangitis

Answer 20

cholestasis
- jaundice, pruritus
- raised bilirubin + ALP
right upper quadrant pain
fatigue

Question 21

Primary sclerosing cholangitis associations

Answer 21

UC mainly but also crohns and HIV

Question 22

Primary sclerosing cholangitis Cx

Answer 22

cholangiocarcinoma (in 10%)
increased risk of colorectal cancer
Cirrhosis and liver failure
Biliary strictures
Fat soluble vitamin deficiencies

Question 23

Primary sclerosing cholangitis Mx

Answer 23

ERCP can be used to dilate and stent any strictures
Ursodeoxycholic acid (may slow disease progression, (reduces biliary cholesterol secretion and cholesterol saturation of gallbladder bile)
Colestyramine for pruritus
Avoid alcohol
Supplement fat soluble vitamines

Question 24

Mirizzi syndrome

Answer 24

common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder

Question 25

US findings

Answer 25

Thickened gallbladder wall
Stones / sludge
Bile Duct Dilatation

Question 26

Percutaneous cholecystostomy indications

Answer 26

for patients with acalculous cholecystitis or reserved for severely-ill patients with ascending cholangitis that is unable to tolerate ERCP.
This is a temporising measure until IV antibiotics improve the clinical situation.

Question 27

Most common bile duct cancer

Answer 27

Adenocarcinoma

Question 28

Bile duct cancer risk factors

Answer 28

> 75 years
Woman
Medical conditions like gallstones, polyps, abnormal bile ducts,Primary sclerosing cholangitis,diabetes
Latin america/asian heritage
Smoking and alcohol
Obesity
Ionising radiation

Question 29

Presentation bile duct cancer

Answer 29

Lump
Loss of appetite, unintentional weight loss
a high temperature, hot/shivery
Sickness
Pain
bile obstruction features - jaundice, pale stools, pruritus

Question 30

Mx Bile duct cancer

Answer 30

Surgery
Chemo
Radiotherapy is not often used to treat gallbladder cancer