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)
