Biliary disease Flashcards
Biliary colic
RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common.
Cholethiasis risk factors
Fat, fair, female (oestrogen) , fourty
Biliary colic Tx
NSAID, such as diclofenac or indometacin,
with an anti-spasmodic eg hycosine if needed.
Paracetamol might be enough
Cholecystitis
Inflammation of the gallbladder + fever +tenderness RUQ
Acute cholecystitis pathophysiology
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.
acalculous cholecystitis
Gallbladder inflammation in absence of stones, 10% of cases
in immunosuppressed patients it may develop secondary to Cryptosporidium or cytomegalovirus
Acute cholecystitis clinical presentation
RUQ pain
may have fever
pain may radiate to back or right shoulder
Murphy sign
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
Boas sign
hyperaesthesia felt by the patient to light touch in the right lower scapular region or the right upper quadrant of the abdomen.
Acute cholecystitis Tx
Early laparoscopic cholecystectomy (to be carried out within 1 week of diagnosis)
Gall bladder empyema
Infected tissue and pus in gall bladder
commonly caused by Ecoli
Choledocholithiasis
gallstone(s) in the bile duct
Choledocholithiasis clinical presentation
pain + jaundice, NO fever
Acute cholangitis
Infection and obstruction of the biliary system
Causes of infection in ascending cholangitis
Escherichia coli is the most common causative agent for ascending cholangitis and then it is followed by Klebsiella
Charcot pentad
Fever (rigors are common)
Jaundice
RUQ pain
hypotension
altered mental status
(acute cholangitis)
Acute cholangitis Tx
IV broad spectrum Abx
supportive measures: o2, Fluids, May need electrolyte
Endoscopic retrograde cholangiopancreatography (ERCP)
primary biliary cirrhosis/cholangitis
All the Ms
IgM
Middle aged female
AMA
Primary sclerosing cholangitis iX
MRCP
showing multiple biliary strictures giving a ‘beaded’ appearance
p-ANCA may be positive
Features of Primary sclerosing cholangitis
cholestasis
- jaundice, pruritus
- raised bilirubin + ALP
right upper quadrant pain
fatigue
Primary sclerosing cholangitis associations
UC mainly but also crohns and HIV
Primary sclerosing cholangitis Cx
cholangiocarcinoma (in 10%)
increased risk of colorectal cancer
Cirrhosis and liver failure
Biliary strictures
Fat soluble vitamin deficiencies
Primary sclerosing cholangitis Mx
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
Mirizzi syndrome
common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder
