Biliary Disease Flashcards
What are the risk factors for gallstones?
4 F’s: Fat, forty, female and fair
Explain the presentation gallstones
- Can be asymptomatic or present with biliary colic: Severe colicky epigastric/RUQ pain, often triggered by high fat meals, can last from 3-8hours and may be associated with nausea/vomiting
Why does high fat meals cause biliary colic?
Fat entering the digestive system causes cholecystokinin release from the duodenum which triggers the contraction of the gallbladder
What are the definitions for the following:
- Cholestasis,
- Cholelithiasis,
- Cholecystitis,
- Cholangitis
- Cholestasis: Blockage to flow of bile.
- Cholelithiasis: Gallstones present
- Cholecystitis: inflammation of the gallbladder
- Cholangitis: Inflammation of the bile duct
What are features of gallstones?
They can be pure cholesterol or bile pigment or a mixture of both.
Describe how gallstones can form?
Bile because lithogenic for cholesterol if there is excessive secretion of cholesterol or if there is decreased secretion of bile salts.
Excessive bilirubin can also precipitation.
Describe the appearence of stools and urine if pre-hepatic, hepatic and post-hepatic causes of jandice
Post hepatic - Dark urine and pale stools.
Hepatic - Dark urine and normal stools
Pre hepatic - Normal urine and normal stools. This is because the liver conjugates bilirubin, making it water soluble.
What are the investigations and treatments for gallstones?
Investigations: MRCP (MRI scan that looks at bile duct), endoscopic ultrasound and operative cholangiogram.
Treatment: ERCP, lap chole and bile duct imaging/clearance
What does raised AST/ALT or raised ALP mean?
Raised AST and/or ALT indicated hepatocellular injury.
Raised ALP indicates cholestasis.
However ALP can be raised with bone pathology, AST might be raised in muscle pathology.
What lab result indicates pancreatitis and what is the presentation?
Raised amylase.
Pancreatitis can present with severe epigastric pain which can radiate through to the back with associated vomiting.
What are the causes of pancreatitis
3 main: Gallstones (as they can cause a reflux of bile through the pancreatic duct), alcohol and post ERCP.
Or I GET SMASHED which stands for Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidaemia, ERCP and Drugs
What are the complications of acute pancreatitis?
- Fat necrosis of pancreas/other organs if there is release of pancreatic enzymes,
- Acute haemorrhagic pancreatitis,
- Pancreatic abscess (occurs due to necrosis or haemorrhagic pancrease. Requires drainage or necrosectomy plus abx),
- Development of chronic pancreatitis.
What are the differential diagnoses of a pancreatic cyst
- Intraductal papillary mucinous neoplasm,
- Mucinous cyst,
- Serous cystadenoma
Describe features of carcinomas of the pancreas
- Most common subtype is ductal adenocarcinoma. Often has perineural invasion.
- Premalignancy is called a pancreatic intraepithelial neoplasm
- The main risk factor is smoking but germline mutations (BRCA) account for small proportion.
- Very poor survival rate
What are the signs and symptoms of pancreatic cancer
- As they commonly occur in the head of pancreas you can get PAINLESS, obstructive jaundice.
- New onset diabetes,
- Abdominal pain due to pancreatic insufficiency or nerve invasion.
- May obstruct bile and pancreatic duct causing the ‘double duct sign’ on radiology
