Biliary Tract Disease Flashcards
What are the symptoms of gallstones?
Mostly asymptomatic
Colic
What ar the complications of gallstones?
Cholecystitis Jaundice Cholangitis Acute Pancreatitis Gallstone Ileus = Bowel Obstruction
What are the risk factors for Gallstones?
Over 40 Female High fat diet Obesity Pregnancy Hyperlipidaemia Bile salt loss (Crohn's) Diabetes Dysmotility of GB Prolonged fasting Total parenteral nutrition
What is the pathogenesis of gallstones?
Abnormal bile composition
Bile stasis and infection
What are the different types of gallstones?
Cholesterol stones
Pigment stones (excess billirubin due to haemolysis)
Mixed stones (most common)
Primary bile duct stones (very rare)
What are the features of biliary colic due to gallstones?
Stones impact in cystic duct Gradual build up of RUQ pain Radiates to back/shoulder May last 2-6 hours Associated with indigestion/nausea
What is the differential for several acute epigastric pain?
Biliary colic Peptic ulcer disease Oesophageal spasm MI Acute pancreatitis
What are the key steps for investigating gallstones?
Ultrasound
MRCP
What is the treatment for biliary colic?
Pain killers
Low fat diet, lose weight if obese
Observe for 3-6 months
Consider surgery referral of pain/colic is still recurrent
Which elective surgery may be performed for symptomatic gallstones?
Laparoscopic cholecystectomy
What is acute cholecystitis?
Inflammation in the gallbladder due to obstruction of the cystic duct
Initially sterile, then becomes infected
What is the treatment of acute cholecystitis?
IV antibiotics and IV fluids
Nil by mouth
US to confirm
Urgent cholecystectomy (usual) or interval cholecystectomy
How does a gallstone ileus occur?
Big gallstone gets into the intestine, blocks distal ileum and causes bowel obstruction
Generally due to the existence of a fistula between the ileum and duodenum
When might gallstones cause jaundice?
When they block the common bile duct
How might gallstones be removed from the CBD?
ERCP
Surgical if very large
What is the difference between an MRCP and ERCP?
MRCP = diagnosis ERCP = treatment
What is the treatment for gallstone ileus?
Urgent laparotomy
Interval cholecystectomy in 3 months (not in elderly or frail)
What is cholangitis?
Bile duct infection
What is cholangiocarcinoma?
Second most common hepatobiliary cancer
What is the clinical presentation of cholangiocarcinoma?
Jaundice Weight loss Anorexia Lethargy Often late, and so lymph node and distant metastases present
How is a cholangiocarcinoma staged?
US
CT/ERCP/PTC
MRI/MRCP/MRA
What curative surgery exists for cholangiocarcinoma?
Surgical resection of bile duct and liver
What palliative treatment exists for cholangiocarcinoma?
Biliary stent
Charcot’s Triad
Associated with acute cholangitis
Fever
Jaundice
Abdominal pain
What are the symptoms of acute cholangitis?
Continuous epigastric or right upper quadrant pain Vomiting Fever Peritonism Gall Bladder Mass
