biliary tract and gallbladder

Question 1

gallstone are more common in

Answer 1

women

Question 2

how can crohns lead to gallstones

Answer 2

cause bile salt loss

Question 3

gallstone pathophysiology

Answer 3

if the concentrations of bile vary gallstones may form

Question 4

cholesterol stones

Answer 4

formed by crystallisation of cholesterol in micelle surface - cholesterol precipitated out of bile to form solid stones

Question 5

5 F for gallstones

Answer 5

female 
fair 
fat 
forty 
fertile

Question 6

causes of cholesterol gallstones

Answer 6

bile supersaturated with cholesterol - excess cholesterol
not enough bile acids ro salts
gallbladder stasis or inactivity

Question 7

can cholesterol be seen on XR

Answer 7

no - radiolucent

Question 8

pigment stones

Answer 8

excess bilirubin combines with calcium

Question 9

are pigment stones seen on XR

Answer 9

yes - calcium

Question 10

how do pigment stones form

Answer 10

excess bilirubin due to excess haemolytic e.g. haemolytic anaemia

Question 11

management of gallstones

Answer 11

MRCP to view

ERCP to remove

Question 12

if gallstones effect the CBD what happens

Answer 12

jaundice, itch, nausea, anorexia

Question 13

Cholecystitis

Answer 13

inflammation of the gallbladder

Question 14

what is Cholecystitis usually associated with

Answer 14

gallstones lodged in cystic duct

Question 15

clinical features of Cholecystitis

Answer 15

pain - midepigastric. can lead to nausea and vomiting
pain can radiate to right shoulder and RUQ
murphys sign positive

Question 16

acute Cholecystitis

Answer 16

Gallstones obstructing outflow of bile and subsequent infection

Question 17

acute Cholecystitis CF

Answer 17

fever, inc WCC, RUQ pain

Question 18

chronic Cholecystitis

Answer 18

chronic inflammation with/out colic

Question 19

chronic Cholecystitis CF

Answer 19

flatulence, fat intolerance

Question 20

Cholecystitis treatment

Answer 20

IV antibiotics/fluid
NJ nil by mouth
US to confirm
urgent cholecystectomy

Question 21

biliary colic

Answer 21

a symptom of gallstones

gallstone lodged in bile duct

Question 22

biliary colic CF

Answer 22

RUQ pain - radiate to back or shoulder

no fever, WCC, or jaundice

Question 23

biliary colic pain

Answer 23

typically inc for 15 min and then sustain for 6 hours till gallstone dislodges

Question 24

biliary colic diagnosis confirmed by

Answer 24

US

Question 25

biliary colic treatment

Answer 25

cholecystectomy

Question 26

gallstone ileus

Answer 26

Repeated cholecystitis causes cholecystoenteric fistula to form. Gallstone becomes lodged in small bowel via cholecystoenteric fistula.

move down small bowel causing intermittent colic and tends to get stuck at ileum or ileocaecal valve causing obstruction

Question 27

gallstone ileus CF

Answer 27

nausea and indigestion

abdominal distension

Question 28

gallstone ileus treatment

Answer 28

urgent laparotomy - SB enterotomy to remove stone

Question 29

gallbladder adenocarcinoma prognosis

Answer 29

poor as often isn’t caught till later stages

Question 30

gallbladder cancer Treatment

Answer 30

cholecystectomy

Question 31

Cholangiocarcinoma

Answer 31

adenocarcinoma

Question 32

Cholangiocarcinoma CF

Answer 32

obstructive jaundice

Question 33

Cholangiocarcinoma investigation

Answer 33

duplex US
CT
MRCP

Question 34

Cholangiocarcinoma palliative treatment

Answer 34

biliary stent

Question 35

Cholangiocarcinoma cure

Answer 35

surgical resection - whipples

Question 36

what happens if gallstone migrate into CBD

Answer 36

jaudice, itch, nausea and anorexia
cholangitis
acute pancreatitis

Question 37

what are the CF of ascending cholangitis

Answer 37

pale stools and dark urine
charcots triangle
pruritis

Question 38

charcots triangle

Answer 38

jaundice, fever and RUQ pain

Question 39

investigations for ascending cholangitis

Answer 39

FBC, UandE, CRP

obstructive jaundice

Question 40

ascending cholangitis treatment

Answer 40

ERCP removal, sphincterotomy or stenting

laparoscopic cholecystectomy