biliary stuff

Question 1

Biliary tract infection. which antibiotic used?

Answer 1

Ciprofloxacin (Bi Ci)

Question 2

what is cholethiasis?

Answer 2

gallstones

Question 3

what are cholesterol stones

Answer 3

cholesterol stones (crystallized cholesterol in micelle surface)

Question 4

why would you have excess cholesterol in bile?

Answer 4

female, obesity, diabetes, genetic

Question 5

what are pigment stones?

Answer 5

excess bilirubin is deposited on surface of bile salt micelle

Question 6

why would you get excess bilirubin ?

Answer 6

excess haemolysis

Question 7

most stones are which type?

Answer 7

most are mixed but pure stones do occur

Question 8

what are the five Fs of gallstones?

Answer 8

FAT, FAIR, FEMALE, FORY, FERTILE

Question 9

what is cholecystitis?

Answer 9

inflammation of the gallbladder, usually associated with gallstones

Question 10

what happens in acute cholecystitis?

Answer 10

gallstones obstruct outflow of bile and get subsequent infection
emypyema, rupture, intense peritonitis

Question 11

what is the gallbladder wall like in chronic cholecystitis?

Answer 11

thickened due to fibrosis but not distended

Question 12

why do you get biliary colic

Answer 12

stone impacts in the cystic duct

Question 13

what is a gallstone ileus?

Answer 13

gallstone impacted in the distal ileum

Question 14

how long would biliary colic last ?

Answer 14

2-6 hours

Question 15

what is biliary colic assocaited with?

Answer 15

indigestion nausea

Question 16

how do you get a gallstone in the small bowel?

Answer 16

fistulation between gallbladder and duodenum (the sit together)

Question 17

gallstone ileus - you get signs and symptoms of?

Answer 17

small bowel obstruction

Question 18

treatment of gallstone ileus?

Answer 18

urgent laparotomy to remove stone

Question 19

tx of cholecystitis?

Answer 19

IV antibiotics,fluids,nil by mouth

cholystectomy

Question 20

what factors promote gallstone formation>

Answer 20

High concentration of cholesterol in the gallbladder
Gallbladder stasis
Products that promote the crystallisation of cholesterol

Question 21

halo effect around gallbladder?

Answer 21

cholycstitis

Question 22

how does cholysystitis come about ?

Answer 22

blockage in neck of gallbladder or cystic duct

Question 23

95% of cases of cholecystitis are due to ?

Answer 23

gallstones

Question 24

symptoms of cholecystitis ?

Answer 24

prolonged pain, fever and leucocytosis

Question 25

what is murphy sign ?

Answer 25

RUQ pain worse on inspiration.

Question 26

how do you elicit murphy sign

Answer 26

ask patient to breath in, put your hand under ribs. gallbladder will come into contact with your hand.

Question 27

what complication can you get as a result of gallstones which would cause an increase in amylase?

Answer 27

acute pancreatitis

Question 28

what would be detected on USS if gallstones were present?

Answer 28

stones, gallbladder wall thickening and dilated common bile duct

Question 29

complications of cholecystitis?

Answer 29

bacterial infection and empyema

Question 30

if gallstones present - what is usually done before cholycystectomy?

Answer 30

ERCP

Question 31

woman with known gallstones presents with EPIGASTRIC pain and nausea>

Answer 31

pancreatitis

Question 32

asymptomatic stones in gallbladder. treatment

Answer 32

they are common and do not require treatment - however, if they are in the common bile duct there is an increased risk of complications, so surgical management should be considered