Biliary Disease

Question 1

What is the meaning of cholelithiasis?

Answer 1

Stones in the gall bladder

Question 2

What are the risk factors for gallstones?

Answer 2

Female (gender, pregnancy, OCP) obesity, advancing age, ethnicity, rapid weight reduction, gallbladder stasis, hyperlipidaemia

Question 3

What are the two types of gallstones?

Answer 3

Cholesterol stones

Pigment stones

Question 4

How are cholesterol stones formed?

Answer 4

The concentration of cholesterol exceeds the saturating capacity of bile and a precipitate forms.

Question 5

What are the four conditions required for cholesterol stone formation?

Answer 5

Gallbladder stasis, supersaturation of cholesterol in bile, establishment of nucleation sites by microprecipitates of calcium salts, mucus hypersecretion to trap the crystals.

Question 6

What ethnicities are more predisposed to gallstones?

Answer 6

Western society predisposed over developing nations.

Question 7

What proportion of people with gallstones become symptomatic?

Answer 7

20-30% become symptomatic at some point in their life.

Question 8

What are the symptoms of biliary colic?

Answer 8

Excruciating constant or colicy RUQ pain.

Question 9

What are the possible complications of biliary colic?

Answer 9

Empyema, perforation, fistulae, inflammation of the biliary tree and obstructive cholecystitis or pancreatitis.

Question 10

What is the difference between cholelithiasis and cholecystitis?

Answer 10

Cholecystitis requires inflammation of the gallbladder, almost always associated with gallstones.

Question 11

What would an enlarged gallbladder look like?

Answer 11

enlarged and tense, bright red or blotchy, violacous to green-black discolouration.
May contain bile with fibrin, blood and pus.

Question 12

What causes the inflammation in cholecystitis?

Answer 12

Phospholipases derived from the mucosa hydrolyse biliary lecithin to lysolecithin which is toxic to the biliary mucosa. The mucosal layer is disrupted, leaving the mucosal epithelium exposed to the detergent action of the bile salts.
May also get distension and increased intraluminal pressure leading to decreased blood flow to the mucosa.

Question 13

What are some causes of acalculous cholecystitis?

Answer 13

post-operative state, severe trauma, severe burns, sepsis

Question 14

What is the possible mechanism for acalculous cholecystitis?

Answer 14

dehydration, gallbladder stasis and sludging, vascular compromise and bacterial contamination.

Question 15

What is meant by chronic cholecystitis?

Answer 15

Long term inflammation of the gall bladder without an acute blockage of the bile outflow tract.

Question 16

What is the means of diagnosis of cholecystitis?

Answer 16

Detection of gallstones or dilated ducts on USS of the gall bladder.

Question 17

What are the possible complications of cholecystitis?

Answer 17

Bacterial infection
gallbladder perforation
gallbladder rupture
biliary enteric fistula
aggravation of pre-existing medical illness

Question 18

What is charcot’s triad?

Answer 18

Upper Right hand Quadrant pain, Fever, obstructive jaundice.

Question 19

What are the possible symptoms of choledocholithiasis?

Answer 19

Biliary obstruction
pancreatitis
cholangitis
hepatic abscess
chronic liver disease
cholecystitis

Question 20

What bacteria are likely to cause cholangitis?

Answer 20

E coli, klebsiella, clostridium, bacteroides, enterobacter

Question 21

What defines cholangitis?

Answer 21

Acute inflammation in the wall of the bile ducts. Almost always caused by bacterial infection.
It can result from anything that obstructs bile flow.
Risk of infecting the intrahepatic biliary ducts.