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Liver and Friends > Biliary Tract disease > Flashcards

Biliary Tract disease Flashcards

1
Q

What is biliary colic definition?

A

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.

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2
Q

Epidemiology of biliary colic

A

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.

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3
Q

RFs for biliary colic

A

4Fs -Fat, female, forty fertile
Diabetes
FH
Crohns

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4
Q

Pathophysiology of bilary colic

A

The pain occurs when a stone impacts against the cystic duct during contraction of the gallbladder with increased pressures in the gallbladder itself.

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5
Q

S + S of biliary colic

A
  • Nausea and vomiting
  • Right upper quadrant pain
  • Epigastric pain
  • Pain may radiate to right shoulder or interscapular region
  • last 30mins - 6 hours
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6
Q

1st line investigation for biliary colic

A

Abdominal US
LFTs

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7
Q

DDs for biliary colic

A
  • IBS
  • Cholecystitis
  • Ascending cholangitis
  • Common bile duct stone
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8
Q

Symptomatic management for bilary colic

A

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

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9
Q

Surgical management for biliary colic

A

MRCP +/- ERCP
On table cholangiogram

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10
Q

Complications of biliary colic

A

Obstructive jaundice
Cholecystitis
Gallstone ileus
Acute pancreatitis

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11
Q

What is acute cholecystitis

A

Acute cholecystitis refers to inflammation of the gallbladder most commonly occurring due to impacted gallstones (calculous cholecystitis)

Rare when it occurs without gallstones

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12
Q

RFs for acute cholecystitis

A

4Fs

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13
Q

What happens in obstruction of gallbladder emptying?

A

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

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14
Q

Acute calculous cholecystitis pathophysiology

A

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

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15
Q

Acute acalculous cholecystitis pathophysiology

A

gallbladder inflammation in the absence of gallstones.
V. rare
RFs:
Diabetes
Age
recent surgery
Sepsis

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16
Q

S + S of Acute cholecystitis

A
  • Signs: RUQ abdom tenderness - murphys positive sign
  • Mass
  • Pyrexia
  • Tachycardia
  • Symp: N/V, fever, RUQ pain
17
Q

1st line Investigations for acute cholecystatitis

A

FBC - leukocytosis with neutrophila
LFTs
U&Es
Venous blood gas
GS = Abdominal US

18
Q

DDs for acute cholecystitis

A
  • Pancreatitis
  • Peptic ulcer disease
  • Cholangitis
  • Appendicitis
19
Q

1st line management for acute cholecystitis

A
  • Nil by mouth
  • IV fluidsand analgesia
  • Intravenous antibiotics
  • Early laparoscopic cholecystectomy - one week of diagnosis
20
Q

2nd line for acute cholecystitis

A

Urgent cholecystostomy

  • ## Performed if early cholecystectomy is inappropriate due to suspected sepsis/gangrene/perforation
21
Q

Complications of acute cholecystitis

A
  • Gallstone ileus:when a gallstone passes from the biliary tract into the intestine via a fistula resulting in small bowel obstruction
  • Acute cholangitis: infection of the biliary tree commonly caused by gallstones which move into the common bile duct
  • Obstructive jaundice: if stone moves to CBD
22
Q

What is Chronic Cholecystitis

A

Chronic inflammation of the gallbladder +/- colic

23
Q

Pathophysiology of chronic cholecystits

A
  • Repeated lodging and dislodging of gallstone in CBD, causing inflammation and fibrosis of the gallbladder
  • In some cases, there may not be lodging and dislodging of gallstones. Instead, gallstones within the gallbladder can cause irritation to the gallbladder and causes damage this way.
  • Overtime, this leads to inflammtion, fibrosis and maybe even calcification. This is known as porcelain gallbladder. This makes the gallbladder visible on x-ray
24
Q

S + S of chronic cholecystitis

A
  • Flatulent dyspepsia
  • RUQ pain (esp after meal)
  • Distension
  • Nausea
  • Fat intolerance
25
Q

Investigations for chronic cholecystitis

A
  • Ultrasound - to image stone and assess CBD diameter
  • MRCP - used to find CBD stones
  • X-ray - may show porcelain gallbladder
26
Q

DDs for chronic cholecystitis

A
  • Hiatus hernia
  • IBS
  • Peptic ulcer
  • Chronic pancreatitis
  • Tumour
27
Q

Management of chroniccholecystitis

A
  • Cholecystectomy
    • ERCP + sphincterectomy prior to surgery

Liver and Friends (17 decks)

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