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Study Notes - Gastroenterology > *Biliary Tract and Pancreas Disorders 2 (Lecture 10) > Flashcards

*Biliary Tract and Pancreas Disorders 2 (Lecture 10) Flashcards

1
Q

What are the 2 categories of biliary tract disease?

A

Gallstones

Bile duct cancer

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2
Q

Do most gallstones cause symptoms?

A

No, most are asymptomatic (10-30% of local population have gallstones)

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3
Q

What problems can symptomatic gallstones cause? (6)

A 
Colic
Cholecystitis
Cholangitis
Jaundice
Pancreatitis
Bowel obstruction (gallstone ileus)
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4
Q

What is biliary colic?

A

term used to describe a type of pain related to the gallbladder that occurs when a gallstone transiently obstructs the cystic duct and the gallbladder contracts

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5
Q

What are the risk factors for the development of gallstones? (10)

A 
5 Fs:
Female
Fat (obesity, high fat diet)
Forty/ fifty
Fertile (pregnancy)
Fair (more common in caucasians)
Also:
Bile salt loss (Crohns)
Diabetes
Dysmotility of GB
Prolonged fasting
TPN
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6
Q

What type of gallstones are pure black?

A

Pigment

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7
Q

What is a 4th rare type of gallstones?

A

Primary bile duct stones (choledocholithiasis)

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8
Q

What are the features of biliary colic?

A

Gradual build up pain in RUQ (when it eases it leaves a bruised/ aching feeling for a few days - can also cause epigastric pain)
Radiates to back/ shoulder
Associated with indigestion/ nausea

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9
Q

Does acute cholecystitis cause gallbladder distension?

Does chronic cholecystitis cause gallbladder distension?

A 
Acute = distended
Chronic = not distended
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10
Q

When does gallstone pain tend to come on?

A

After eating a big fatty meal

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11
Q

How are gallstones diagnosed?

A 
US
CT scan
MRCP/ ERCP
HIDA
EUS
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12
Q

What is a HIDA scan?

A

stands for hepatobiliary iminodiacetic acid scan, creates pictures of your liver, gallbladder, biliary tract and small intestine

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13
Q

What is the treatment of biliary colic? (5)

A

Pain killers
Low fat diet/ lose weight if obese
Observe in 3-6 months
If the patient is getting recurrent episodes of pain consider elective cholecystectomy
If patient unfit, try to dissolve gallstones with ursodeoxycholic acid

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14
Q

Treatment of acute cholecystitis? (5)

A 
IV antibiotics and IV fluids
Nil by mouth
US to confirm diagnosis
Urgent cholecystectomy (asap) OR
Internal cholecystectomy depending on how inflamed the gall bladder s (antibiotics and come back in 3 months)
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15
Q

What complications of gallstones occur when the stone migrate into the CBD? (3)

A

Jaundice
Cholangitis
Acute pancreatitis

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16
Q

What is the difference between biliary colic and cholecystitis?

A

When the stone(s) passes into the cystic duct it causes pain and is called biliary colic
If this occurs for a prolonged period of time, it causes gallbladder inflammation (cholecystitis)

17
Q

What is cholangitis?

A

Inflammation of the bile duct system that is usually related to a bacterial infection - usually caused by a bloackage

18
Q

What symptoms suggest a common bile duct pathology? (5)

A 
Itch
Nausea
Anorexia
Jaundice
Abnormal LFTs
19
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangio pancreatography

20
Q

What is ERCP used for?

A

Diagnosis and treatment of pancreatic and bile duct problems e.g. gallstone removal

21
Q

How can stones within the CBD be removed?

A

ERCP
Laparoscopically
Open surgery

22
Q

How is acute pancreatitis due to gallstones treated?

A

Cholecystectomy

ERCP/ ES if frail

23
Q

What is gallstone ileus?

How does it form?

A

Small bowel obstruction due to gallstone impacted in distal ileum
Fistula forms between the gallbladder and duodenum allowing a large gallstone to pass into the small intestine causing obstruction (moves down the SB causing intermittent colic, present with distal SB obstruction)

24
Q

What is colic?

A

form of pain that starts and stops abruptly. It occurs due to muscular contractions of a hollow tube (colon, ureter, gall bladder, etc.) in an attempt to relieve an obstruction by forcing content out.

25
Q

How is gallstone ileus treated?

A

Urgent laparotomy
SB enterotomy to remove stone
Interval cholecystectomy in 3 months (if the patient is old and frail the stone is removed and there is not usually a cholecystectomy)

26
Q

What type of patients does gallstone ileus normally occur in?

A

Elderly women

27
Q

How do patients with cholangiocarcinoma usually present? (6)

A 
Jaundice
Weight loss
Anorexia
Lethargy
50% = lymph node metastases
20-30% = peritoneal metastases
28
Q

Staging/ assessment of cholangiocarcinoma?

A

Duplex US
CT/ ERCP/ PTC
MRI/ MRCP/ MRA

29
Q

what is PTC?

A

Precutaneous transhepatic cholangiography - 1dye delineates the biliary tract on the x-ray images and reveals any significant abnormalities

30
Q

What is MRA?

A

Magnetic resonance angiography

31
Q

What is the only chance of cure of cholangiocarcinoma?

A

Surgical resection (nile duct and liver resection)

32
Q

what palliative treatment can be given for cholangiocarcinoma/

A

Biliary stent (ERCP/ PTC insertion)

Study Notes - Gastroenterology (42 decks)

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