*Biliary Tract and Pancreas Disorders 2 (Lecture 10) Flashcards
What are the 2 categories of biliary tract disease?
Gallstones
Bile duct cancer
Do most gallstones cause symptoms?
No, most are asymptomatic (10-30% of local population have gallstones)
What problems can symptomatic gallstones cause? (6)
Colic Cholecystitis Cholangitis Jaundice Pancreatitis Bowel obstruction (gallstone ileus)
What is biliary colic?
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
What are the risk factors for the development of gallstones? (10)
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
What type of gallstones are pure black?
Pigment
What is a 4th rare type of gallstones?
Primary bile duct stones (choledocholithiasis)
What are the features of biliary colic?
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
Does acute cholecystitis cause gallbladder distension?
Does chronic cholecystitis cause gallbladder distension?
Acute = distended Chronic = not distended
When does gallstone pain tend to come on?
After eating a big fatty meal
How are gallstones diagnosed?
US CT scan MRCP/ ERCP HIDA EUS
What is a HIDA scan?
stands for hepatobiliary iminodiacetic acid scan, creates pictures of your liver, gallbladder, biliary tract and small intestine
What is the treatment of biliary colic? (5)
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
Treatment of acute cholecystitis? (5)
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)
What complications of gallstones occur when the stone migrate into the CBD? (3)
Jaundice
Cholangitis
Acute pancreatitis
What is the difference between biliary colic and cholecystitis?
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)
What is cholangitis?
Inflammation of the bile duct system that is usually related to a bacterial infection - usually caused by a bloackage
What symptoms suggest a common bile duct pathology? (5)
Itch Nausea Anorexia Jaundice Abnormal LFTs
What does ERCP stand for?
Endoscopic retrograde cholangio pancreatography
What is ERCP used for?
Diagnosis and treatment of pancreatic and bile duct problems e.g. gallstone removal
How can stones within the CBD be removed?
ERCP
Laparoscopically
Open surgery
How is acute pancreatitis due to gallstones treated?
Cholecystectomy
ERCP/ ES if frail
What is gallstone ileus?
How does it form?
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)
What is colic?
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.
How is gallstone ileus treated?
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)
What type of patients does gallstone ileus normally occur in?
Elderly women
How do patients with cholangiocarcinoma usually present? (6)
Jaundice Weight loss Anorexia Lethargy 50% = lymph node metastases 20-30% = peritoneal metastases
Staging/ assessment of cholangiocarcinoma?
Duplex US
CT/ ERCP/ PTC
MRI/ MRCP/ MRA
what is PTC?
Precutaneous transhepatic cholangiography - 1dye delineates the biliary tract on the x-ray images and reveals any significant abnormalities
What is MRA?
Magnetic resonance angiography
What is the only chance of cure of cholangiocarcinoma?
Surgical resection (nile duct and liver resection)
what palliative treatment can be given for cholangiocarcinoma/
Biliary stent (ERCP/ PTC insertion)
