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Gastrointestinal (LECTURE NOTES) > Biliary Diseases > Flashcards

Biliary Diseases Flashcards

1
Q

What are some of the consequences of disruption of the flow of bile

A 
Pain
Inflammation
colonisation by micro-organisms 
infection 
loss of essential digestive functions of bile
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2
Q

Why does disruption of bile flow most commonly occur

A

Because of a mechanical blockage caused by biliary stones

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3
Q

What is bile composed of

A 
Water
electrolytes
bile salts 
bilirubin
phospholipds and cholesterol
proteins that regulate GI function
Drugs and drug metabolites
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4
Q

How does the gallbladder concentrate the bile

A

By absorbing 90% of the water content

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5
Q

Where do bile salts circulate

A

Through the entero-hepatic circulation

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6
Q

What is the difference between cholecystitis and cholangitis

A

Infection of gallbladder = cholecystitis

infection of the bile ducts = cholangitis

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7
Q

What are the most common organisms involved in biilary microbiology

A

Gram negatives (Escheria coli, Klebsiella, Enterobacter

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8
Q

What should patients with symptomatic gallstones ave

A

A cholecystectomy

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9
Q

What are gallstones made up of

A

Poorly soluble components of bile precipitated on a three dimensional matrix of mucins and proteins

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10
Q

What are the three main types of gallstones

A

Cholesterol
Black pigment
Brown pigment

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11
Q

What are the vast majority of gallstones in Western countries

A

Cholesterol or mixed type

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12
Q

What are some of the risk factors for cholesterol gallstones

A 
FHx
Age
Female
Pregnancy 
Obesity
Rapid weight loss
Prolonged fasting
Diabetes mellitus 
Crohn's disease 
TPN
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13
Q

What are some of the possible preventative factors

A

High fibre diet
Low consumption of saturated fatty acids
high relative amount of trans-fatty acids
nut consumption
moderate physical activity

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14
Q

What are the clincal features of gallstones

A

Pain (right hypochondrial or epigastric)
Radiates to the upper back or right shoulder
Steady and intense - occurs more than an hour after meals
Often associated with an urge to walk
Each episode lasts 1-24 hours
Murphy’s sign positive
Fever

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15
Q

What are some routine investigations

A

Liver tests
MRCP
US

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16
Q

What are some routine investigations

A

Liver tests
MRCP
US

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17
Q

What is the treatment of choice for gall stones

A

Laparoscopic cholecystectomy

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18
Q

What might be a sufficient treatment for patients with gallstones who are not suitable for surgery

A

ERCP and sphincterotomy

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19
Q

How does acute cholangitis develop

A

When bacterial infection complicates obstruction within the biliary tract

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20
Q

What are some causes of acute bacterial cholangitis

A 
Choledocholithiasis or sludge 
Biliary strictures
Choledochal cysts 
Stenosis of the papilla of Vater 
Parasitic infection 
Iatrogenic (post ERCP)
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21
Q

What is the classical presentation of acute cholangitis

A

Fever
RUP pain
Jaundice

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22
Q

What are the investigations for acute cholangitis

A

Bloods: Serum biochemistry, FBC, clotting screen
Transabdominal US: first step in detecting bile duct stones
MRCP
ERCP - gold standard
Endoscopic US

23
Q

What causes cholecystitis

A

An obstruction of the cystic duct usually by a gallstone

24
Q

What are the clincal features of cholecystitis

A 
Unremitting RUQ pain 
anorexia 
nausea 
vomiting 
fever
25
Q

What is gangrenous cholecystitis

A

Severe acute cholecystitis can lead to necrosis of the gall bladder wall

26
Q

What are some of the complications of cholecystitis

A

Perforation of the gallbladder
Pericholecystic abscess
fistula

27
Q

What is the treatment of choice for cholecystitis

A

Open or laparoscopic cholecystemoctomy EARLY

28
Q

What is meant by Acualculous biliary pain

A

Recurrent biliary type abdominal pain in patients with no evidence of cholelithiasis

29
Q

What are some of the causes of acalculous biliary pain

A

Altered gallbladder motility
Impairment of gallbladder filling
Gallbladder hyperalgesia

30
Q

What is the management for patients with Acalculous biliary pain

A

Usually conservative - treatments target chronic visceral pain

31
Q

What are the three major adult manigestations of cholestasis

A

Primary biliary cirrhosis (PBC)
primary sclerosing cholangitis (PSC)
cholangiocarcinoma

32
Q

What are the three major adult manigestations of cholestasis

A

Primary biliary cirrhosis (PBC)
primary sclerosing cholangitis (PSC)
cholangiocarcinoma

33
Q

Primary sclerosing cholangitis has which sex prodominance

A

Male

34
Q

What does primary sclerosing cholagitis have a strong associateion with

A

IBD - especially UC

35
Q

What occurs in PSC

A

Progressive liver disease that causes inflammation, fibrosis and strictures in the intra-hepatic and extrahepatic bile ducts

36
Q

WHat are the clinical features of PSC

A 
Jaundice
steatorrhoea
pruritus 
weight loss
failure or proper absoroption of calcium and fat soluble vitamins
37
Q

What might be found on examination of suspected PSC

A

Xanthomas of the eyes, neck, chest and back

38
Q

What do the lab tests show in PSC

A

Elevated conjugated bilirubin
An extremely high ALP (more than 3 times the upper limit of normal)
Elevated GGT

39
Q

What is the management for PSC

A

Symptom management

40
Q

What is the only life-extending therapy for PSC

A

Liver transplantation

41
Q

Why do patients with PSC complicating IBD require more frequent colonic surveillance than those with iBD alone

A

Because of the increased risk of colon cancer

42
Q

What is Primary Biliary cirrhosis

A

An autoimmune cholestatic liver disease in which the epithelial cells linign the intrahepatic bile ducts are damaged by the immune system

43
Q

Who does Primary biliary cirrhosis predominantly affect

A

Women ages 30-65

44
Q

What is the male to female ratio of PBC

A

1:10

45
Q

What are the clincal features of PBC

A 
Fatigue 
intense pruritus 
cutaneous hyperpigmentation
xanthelasmas 
hepatosplenomegaly
46
Q

What is PBC often associated with

A

Autoimmune diseases such as scleroderma

thyroiditis and Sjogren’s syndrome

47
Q

What is the management for PBC

A

UDCA ist eh first line treatment in early disease

48
Q

What prolong life in PBC

A

Liver transplant

49
Q

What is cholangiocarcinoma

A

A slow growing malignancy of the bile duct

50
Q

How are at risk of cholangiocarcinoma

A 
Parasitic diseases of the biliary tract 
Congenital choledochal cysts 
IBD
PSC
Hisotry of other malignancy 
Previous surgery for choledochal cyst or biliary atresia 
Alpha 1 antitripsin deficiency 
Autosomall dominant polycycsti ckidneyy disease 
Gallstones 
Papillomatosis of the bile ducts 
thorotrast exposure 
chronic typohoid carrier status
51
Q

What are the clincal features of cholangiocarcinoma

A 
Abdominal pain
palpable masses 
weight loss 
progressive obstructive jaundice 
Hepatomegaly
52
Q

What investigations should be carried out for cholangiocarcinoma

A

US
Abdominal CT
MRCP
ERCP

53
Q

What is the management of cholangiocarcinoma

A

Complete surgical resection
Palliation
Orthotopic liver transplantation

Gastrointestinal (LECTURE NOTES) (29 decks)

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