Biliary pathology Flashcards
A 41 year old female presents with right upper quadrant pain and jaundice. She has a temperature of 38.4 degrees Centigrade and feels generally unwell.
Most likely diagnosis?
Ascending cholangitis
What is the definitive management of Ascending cholangitis?
Endoscopic biliary decompression.
What is the management for acute cholecystitis?
NBM
Fluids
Antibiotics (Cefuroxime)
Analgesia (Paracetamol/NSAID’s)
A laparoscopic cholecystectomy should be carried out within 1 week of the episode of acute cholecystitis.
Clinical presentation of acute cholecystitis?
Right upper quadrant/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated) Fever Nausea and vomiting Right upper quadrant tenderness Murphy's sign positive
How do you diagnose acute cholecystitis?
USS abdomen
What are most gallstones made of?
Cholesterol
What structure does the common bile duct and pancreatic duct drain into before it opens into the duodenum?
Ampulla of vater, surrounded by the sphincter of oddi.
What does cholelithiasis mean?
Gallstones are present
What condition involves inflammation of the bile ducts?
Cholangitis
What condition refers to pus in the gallbladder?
Gall bladder empyema
What procedure involves inserting a drain into the gallbladder?
Cholecystostomy
What are the four memorable risk factors for gallstones?
Fat
Fair
Female
Fourty
What is the characteristic symptom of gallstones?
Biliary colic
What hormone is secreted in response to fat entering the digestive system, causing contraction of the gallbladder?
Cholecystokinin secreted from the duodenum
What do pale stools and dark urine indicate?
Obstruction to flow within the biliary system
What pattern of enzymes will be seen on liver function tests in patients with cholestasis?
ALT and AST can increase slightly, with a higher rise in ALP
What is the first-line investigation in patients with symptoms of gallstone disease?
Ultrasound
What investigation of the biliary system involves an MRI scan?
MRCP
What procedure can be used to assess the biliary system and treat gallstones stuck in the ducts?
ERCP
What typical incision is used in an open cholecystectomy?
A right subcostal “Kocher” incision
What is the more characteristic presenting symptom in acute cholecystitis?
Right upper quadrant pain
What specific sign is suggestive of acute cholecystitis?
Murphy’s sign
What is Charcot’s triad and what does it indicate?
Right upper quadrant pain
Fever
Jaundice (raised bilirubin)
Indicates acute cholangitis
Where do cholangiocarcinomas originate and what is their typical histological type?
Bile ducts and adenocarcinoma
What are the key risk factors for cholangiocarcinoma?
Primary sclerosing cholangitis and liver flukes
What law states that a palpable gallbladder along with jaundice is unlikely to be gallstones?
Courvoisier’s law
What histological type are the majority of pancreatic cancers?
Adenocarcinoma
What organ does pancreatic cancer usually spread to first?
Liver
What sign refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic cancer?
Trousseau’s sign of malignancy
What tumour marker is most relevant in pancreatic cancer?
CA 19-9 (carbohydrate antigen)
What name is given to a pancreaticoduodenectomy procedure, used to treat early pancreatic cancer?
Whipple procedure
What are the three top causes of pancreatitis?
Gallstones
Alcohol
Post-ERCP
What scoring system is used to assess the severity of pancreatitis?
Glasgow score
What enzyme often needs replacing in chronic pancreatitis?
Lipase
What incisions may be used for a liver transplant?
“Rooftop” or “Mercedes Benz” incision
