Biliary tract disease Flashcards
What causes biliary colic?
temporary obstruction of the cystic or CBD by a stone
Symptoms of biliary colic
RUQ pain
Radiates to the back
Often associated with vomiting
Jaundice may be present
Rx biliary colic
analgesia and elective cholecystectomy
rehydrate, NBM
Investigations biliary colic
US showing gallstones
increased serum alkaline phosphatase + bilirubin
what differentiates biliary colic from acute cholecystitis?
absence of inflammatory features
fever, white cell count + local peritonism
what is peritonism?
clinical signs of shock and peritonitis
what causes acute cholecystitis?
the impaction of a stone in the cystic duct or neck of the gallbladder
clinical feutres of acute cholecystitis?
RUQ pain, like biliary colic
fever + tenderness + muscle guarding
tenderness is worse on inspiration
complications acute cholecystitis?
pus and perforation with peritonitis
Ix acute cholecystitis
leucocytosis
abd US: gallstones, distended gallbladder with a thickened wall
serum liver biochem may be mildly abnormal
Mx acute cholecystitis
initially conservative: NBM, fluids, analgesia, IV antibiotics e.g. cefotaxime
colecystectomy done within 48hrs of the acute attack
Chronic cholecystitis is associated with what?
gallstones
incidental finding
US examination of chronic cholecystitis
may be small shrunken gallbladder
symptoms of chronic cholecystis
no evidence of any, and cholecystectomy not indicated
what is ascending cholangitis also known as?
acute cholangitis
what is acute cholangitis (+cause)
infection of biliary tree + occurs secondary to CBD obstruction by gallstones
other: benign biliary strictures after biliary surgery or associated with chronic pancreatitis, PSC, HIV cholangiopathy
Charcot’s triad for acute cholangitis
(Not always present)
fever
jaundice
RUQ pain
What type of jaundice for acute cholangitis?
cholestatic
dark urine, pale stool, skin may itch
Ix acute cholangitis
leucocytosis
+ve blood cultures (e.g. E.coli)
liver biochem: cholestatic picture- raised serum Br and alkaline phosphatase
US: dilated CBD
ERCP: definitive Ix + allows drainage. site, cause + can sample bile
what does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
Mx acute cholangitis
resuscitation + vol replacement, analgesia, IV antibiotics,
biliary drainage/clearance (ESRP)
stent if stones cannot be removed
what is choledocholithiasis
stones in the CBD
US choledocholithiasis
gallbladder stones
may show obstructed CBD containing a stones
Clinical presentation of CBD stones
may be asymptomatic with no features of cholangitis
abnormal liver biochem, usually cholestatic picture
