Biliary Disease Flashcards
what causes biliary colic
gall stones passing through biliary tree
- may become impacted in gall bladder neck or cystic duct which causes pain
presentation of biliary colic
colicky RUQ pain
- provoked by fatty meal
- may radiate to right shoulder
what are the majority of gallstones composed of
cholesterol
risk factors for biliary colic
4 ‘F’s : Female, fertile, fat, forty
- also COP, fibrates, crohns, diabetes, rapid weight loss
Ix for biliary colic
Bloods: LFTs, FBC, U+Es, amylase
USS 1st line - looking for duct dilatation
- MRCP considered if there is duct dilatation and/or abnormal LFTs
non-operative management for biliary colic
analgesia
Nil by mouth, IV fluids
operative management for biliary colic
laparoscopic cholecystectomy
ERCP for stones in the common bile duct
what is cholecystitis?
what is the most common cause?
inflammation of the gall bladder, most commonly develops secondary to gall stones
presentation of cholecystitis
RUQ pain worse on inspiration (Murphy’s sign +ve)
fever, nausea + vomiting
Ix for cholecystitis
USS - thickened gall bladder wall - gallstones - pericholecystic fluid (fluid around gallbladder) Bloods: raised WBC, CRP
management of cholecystitis
IV fluids, analgesia, IV antibiotics (e.g.cefotaxime)
cholecystectomy within 72 hours
surgical management of patients with cholecystitis who are not fit for a cholecystectomy
cholecystostomy
- gall bladder drain in place for 8-12 weeks
what is cholangitis
infection of biliary tree
- most common predisposing factor is gallstones
what organisms most commonly cause cholangitis
E.Coli
Enterococcus
presentation of cholangitis
Charcots triad: fever, RUQ pain, jaundice
what type of jaundice is there in cholangitis?
how does it present?
obstructive jaundice
- dark urine, pale stools, itch
management of cholangitis
antibiotics (IV amoxicillin, metronidazole, gentamicin) + IV fluids
ECRP = definitive Ix + management
what is gallstone ileus
large gallstone erodes through gall bladder into duodenum causing small bowel obstruction
most common causes of acute pancreatitis in UK
alcohol
gall stones
what drugs can cause pancreatitis
thiazides azathioprine sodium valproate tetracyclines mesalazine
I GET SMASHED pneumonic for causes of pancreatitis
Idiopathic (20%) Gallstones (50%) Ethanol (20%) Trauma Steroids Mumps / Malignancy Autoimmune Scorpion sting Hyperlipidaemia + Hypercalcaemia ERCP Drugs
pathophysiology of acute pancreatitis
autodigestion of pancreatic tissue by pancreatic enzymes, leading to necrosis
presentation of acute pancreatitis
epigastric pain that radiates to back
N+V
tenderness, guarding, rigidity on examination
Cullens sign - periumbilical discolouration
Grey-Turners sign- flank discolouration
what is raised in acute pancreatitis
serum amylase / lipase (3x normal limit)
scoring systems for acute pancreatitis
APACHE II
Ranson
what score on
- APACHE II
- Ranson (Glasgow criteria)
indicates severe pancreatitis
APACHE >8
Ranson >3
features indicating severe pancreatitis
age > 55 hypocalcaemia hypoxia hyperglycaemia neutrophilia
imaging for pancreatitis
USS 1st line - used to look for gall stones
CT - gold standard but only needed if diagnosis is uncertain
management of acute pancreatitis
IV fluids, analgesia, antiemetics
antibiotics if signs of infection
if due to alcohol - thiamine, folate, B12 replacement
complications of acute pancreatitis
pancreatic necrosis + infection
pancreatic abscess
pancreatic pseudocyst
what does cholelithiasis mean
gallstones in the gallbladder
what is Mirizzi syndrome
rare complication where stones in the gallbladder or cystic duct cause obstructive jaundice via extrinsic compression of common bile duct
what is Choledocholithiasis
gallstones in the common bile duct
most common cause of chronic pancreatitis
excess alcohol
presentation of chronic pancreatitis
recurrent epigastric pain radiating to back, typically 15-30 mins after a meal
exocrine pancreatic insufficiency – steatorrhea + malnutrition
diabetes
genetic causes of chronic pancreatitis
cystic fibrosis
hyperparathyroidism
haemochromatosis
alpha 1 antitrypsin deficiency
investigations for chronic pancreatitis
Blood glucose
CT
- calcifications
- ductal dilatation
what is decreased in chronic pancreatitis
faecal elastase
management of chronic pancreatitis
analgesia
pancreatic enzyme supplements
diabetes management
