biliary tract and gallbladder Flashcards
gallstone are more common in
women
how can crohns lead to gallstones
cause bile salt loss
gallstone pathophysiology
if the concentrations of bile vary gallstones may form
cholesterol stones
formed by crystallisation of cholesterol in micelle surface - cholesterol precipitated out of bile to form solid stones
5 F for gallstones
female fair fat forty fertile
causes of cholesterol gallstones
bile supersaturated with cholesterol - excess cholesterol
not enough bile acids ro salts
gallbladder stasis or inactivity
can cholesterol be seen on XR
no - radiolucent
pigment stones
excess bilirubin combines with calcium
are pigment stones seen on XR
yes - calcium
how do pigment stones form
excess bilirubin due to excess haemolytic e.g. haemolytic anaemia
management of gallstones
MRCP to view
ERCP to remove
if gallstones effect the CBD what happens
jaundice, itch, nausea, anorexia
Cholecystitis
inflammation of the gallbladder
what is Cholecystitis usually associated with
gallstones lodged in cystic duct
clinical features of Cholecystitis
pain - midepigastric. can lead to nausea and vomiting
pain can radiate to right shoulder and RUQ
murphys sign positive
acute Cholecystitis
Gallstones obstructing outflow of bile and subsequent infection
acute Cholecystitis CF
fever, inc WCC, RUQ pain
chronic Cholecystitis
chronic inflammation with/out colic
chronic Cholecystitis CF
flatulence, fat intolerance
Cholecystitis treatment
IV antibiotics/fluid
NJ nil by mouth
US to confirm
urgent cholecystectomy
biliary colic
a symptom of gallstones
gallstone lodged in bile duct
biliary colic CF
RUQ pain - radiate to back or shoulder
no fever, WCC, or jaundice
biliary colic pain
typically inc for 15 min and then sustain for 6 hours till gallstone dislodges
biliary colic diagnosis confirmed by
US
biliary colic treatment
cholecystectomy
gallstone ileus
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
gallstone ileus CF
nausea and indigestion
abdominal distension
gallstone ileus treatment
urgent laparotomy - SB enterotomy to remove stone
gallbladder adenocarcinoma prognosis
poor as often isn’t caught till later stages
gallbladder cancer Treatment
cholecystectomy
Cholangiocarcinoma
adenocarcinoma
Cholangiocarcinoma CF
obstructive jaundice
Cholangiocarcinoma investigation
duplex US
CT
MRCP
Cholangiocarcinoma palliative treatment
biliary stent
Cholangiocarcinoma cure
surgical resection - whipples
what happens if gallstone migrate into CBD
jaudice, itch, nausea and anorexia
cholangitis
acute pancreatitis
what are the CF of ascending cholangitis
pale stools and dark urine
charcots triangle
pruritis
charcots triangle
jaundice, fever and RUQ pain
investigations for ascending cholangitis
FBC, UandE, CRP
obstructive jaundice
ascending cholangitis treatment
ERCP removal, sphincterotomy or stenting
laparoscopic cholecystectomy
