Biliary Tract Disease Flashcards
What 5 things can gallstones cause
Colic Cholecystitis Jaundice Pancreatitis (can be fatal) Bowel Obstruction (unusual)
Why is there more chance of getting gall stones as you get older
The level of cholesterol in the body increases
bile gets stickier so it is more likely to become grit like
What are the most common type of gall stones
Mixed stones
What is the rarest type of gall stones
Primary bile duct stones
What are the other 2 types of gall stones
Cholesterol or pigment stones
What are the 5 Fs for gallstones
Forty or fifty Female Fat Fertile Fair ethnicity
What are the symptoms of biliary colic
Stone impacts in the cystic duct Gradual build up pain in RUQ Radiates to back/ shoulder May last 2-6 hours Associated with indigestion / nausea
What are 5 causes of severe acute epigastric pain
Biliary colic Peptic ulcer disease Oesophageal spasm Myocardial infarction Acute pancreatitis
How does acute cholecystitis occur
Inflammation in the gall bladder
Obstruction of cystic duct
Initially sterile then becomes infected
Why would you see kidney stones but not gall stones on an x ray
Kidney stones contain calcium and the gall stones don’t
What are 5 different diagnostic tools of gallstones
Ultrasound CT scan MRCP / ERCP HIDA EUS
What is the treatment of acute cholecystitis
IV antibiotics
IV fluids
NBM
US to confirm
What is the preferred option of acute cholecystitis
Urgent cholecystectomy
What might we do for more elderly patients that are frail and unfit
Interval cholecystectomy
What is a major complication of laparoscopic cholecystectomy
Bile duct injury
What happens when the stones migrate into the common bile duct
Jaundice (if blocking)
Infection of bile duct (cholangitis)
Acute pancreatitis
What are the 2 main causes of acute pancreatitis
Alcohol or gallstones
What is the best treatment for acute pancreatitis
Remove the gall bladder to prevent any future stones sticking and causing pancreatitis again
What is Gallstone ileus
gallstone impacted in the distal ileum causing a Small bowel obstruction
Who is most likely to develop a gallstone ileus
Elderly females
Do all gallstones cause symptoms
No
What is the single best test for gall stones?
Ultrasonography to tell us whether there are gall stones or not and where they are
Do we always remove gallstones?
No
Only if they are symptomatic or causing complications
What is cholangiocarcinoma
Bile duct cancer
How common is cholangiocarcinoma
1 in every 100,000
Where is the most common site of cholangiocarcinoma
Perihilar
When do cholangiocarcinoma present
Late
What are the common symptoms of cholangiocarcinoma
Jaundice
Weight loss
anorexia
lethargy
What are 2 complications of cholangiocarcinoma by the time the patient presents
Metastases to the lymph nodes or peritoneal
What is the most common type of care for cholangiocarcinoma
Palliative
What 3 diagnositic tests are used for staging or assessment of cholangiocarcinoma
Suplex ulstrasound
MRI
Spiral CT
How many types of cholanguicarcinoma
4
What can we do for a patient that has not got metastatic disease
Surgery to create a new bile duct
What is the prognosis of cholangiocarcinoma with surgery
50% survival after 5 years
What is a treatment for cholangicarcinoma that has spread and why do we do this?
Biliary stent to relieve symptoms
