Biliary Tract disease Flashcards
What is biliary colic definition?
Biliary colic refers to a pain in the RUQ/epigastrium caused by gallstones.
Though termed a ‘colic’ the pain is normally constant lasting from 30 minutes to 6 hours.
Epidemiology of biliary colic
F > M
It is the most common symptomatic manifestation of cholelithiasis (gallstones) affecting around 10-20% of patients.
More common in caucasians, Native American’s and Hispanics.
RFs for biliary colic
4Fs -Fat, female, forty fertile
Diabetes
FH
Crohns
Pathophysiology of bilary colic
The pain occurs when a stone impacts against the cystic duct during contraction of the gallbladder with increased pressures in the gallbladder itself.
S + S of biliary colic
- Nausea and vomiting
- Right upper quadrant pain
- Epigastric pain
- Pain may radiate to right shoulder or interscapular region
- last 30mins - 6 hours
1st line investigation for biliary colic
Abdominal US
LFTs
DDs for biliary colic
- IBS
- Cholecystitis
- Ascending cholangitis
- Common bile duct stone
Symptomatic management for bilary colic
Analgesia:Simple pain relief with paracetamol and NSAIDs (in the absence of contra-indications). Occasionally opioid analgesia may be required in cases of severe pain.
Low fat diet
Surgical management for biliary colic
MRCP +/- ERCP
On table cholangiogram
Complications of biliary colic
Obstructive jaundice
Cholecystitis
Gallstone ileus
Acute pancreatitis
What is acute cholecystitis
Acute cholecystitis refers to inflammation of the gallbladder most commonly occurring due to impacted gallstones (calculous cholecystitis)
Rare when it occurs without gallstones
RFs for acute cholecystitis
4Fs
What happens in obstruction of gallbladder emptying?
Obstruction leads to increase in gall bladder glandular secretion > progressive distention > compromises vascular supply to gall bladder > Inflammatory response due to retained bile in gallbladder
Acute calculous cholecystitis pathophysiology
Inflammation and infection occur when a stone becomes impacted in the cystic duct > stone leads to impaired drainage of gallbladder contents and the release of inflammatory mediators > bacterial overgrowth, usually involving gram-negative rods or anaerobe
Acute acalculous cholecystitis pathophysiology
gallbladder inflammation in the absence of gallstones.
V. rare
RFs:
Diabetes
Age
recent surgery
Sepsis