Biliary Tract Disease Flashcards
What are components of bile?
Bile pigments from broken down Hb
Cholesterol
Phospholipids
If concentration between different stones vary different stones form, what are 3 types of stone?
Pigment stones (<10%) – small, friable, irregular – haemolysis
Cholesterol stones – large, often solitary – age, obesity, female sex
Mixed stones - faceted (calcium salts, pigment and cholesterol)
90% of stones are asymptomatic, what are risk factors for them becoming symptomatic?
smoking
Parity (giving birth)
What is acute cholecystitis?
Follows stone or sludge impaction at the neck of the gallbladder. Causes inflammation
How does acute cholecystitis present?
continuous epigastric or RUQ pain – referred to right shoulder
Vomitting
Fever
Peritonism
GB mass
In biliary colic, pain occurs when a gall stone blocks the cystic duct or common bile duct. How does acute cholecystitis differ from binary colic?
Inflammatory component in acute cholecystitis (fever, WCC, local peritonism)
There is no inflammatory component in biliary colic
If a gall stone moves into and obstructs the common bile duct what occurs?
Obstructive jaundice and cholangitis (inflammation of bile ducts)
Murphy’s sign is indicative of acute cholecystitis, what is Murphy’s sign?
2 fingers over right upper quadrant
Ask to breath in
Inflamed gallbladder causes pain and arrest of inspiration
Tests for acute cholecystitis?
High WCC
Ultrasound- thick walled, shrunken GB, pericholecystic fluid, stones, CBD dilation
HIDA cholescintigraphy (nuclear imaging technique)
AXR identifies 10% of stones, may show calcified gallbladder
Treatment of acute cholecystitis
Nil by mouth Pain relief IV fluids Cefuroxime Laparoscopic cholecystectomy – either acute or delayed – is treatment of choice
What is chronic cholecystitis
How does it present
Chronic gallbladder inflammation +- colic
Flatulent dyspepsia
What is flatulent dyspepsia?
Vague abdominal discomfort, distention, nausea, flatulence and fat intolerance
What is colic?
Pain that starts and stops abruptly. It occurs due to muscular contractions of a hollow tube, in an attempt to relieve an obstruction by forcing content out.
Tests for chronic cholecystitis?
Ultrasound to image stones and assess CBD diameter
MRCP (magnetic resonance cholangiopancreatography)
to find CBD stones
Treatment for chronic cholecystitis?
cholecystectomy
What is biliary colic?
Pain due to a gall stone temporarily blocking the cystic duct or bile duct
(no inflammation)
How does biliary colic present clinically?
RUQ pain radiates tot he back +- jaundice
Treatment of biliary colic
Analgesia
Nill by mouth
Rehydrate
Elective cholecystectomy
How does cholangitis (biliary tract inflammation) present?
RUQ pain, rigors, jaundice- Charcot’s triad
How is cholangitis treated?
Cefuroxime and Metronidazole
Complications of gallstones in gallbladder and cystic duct
Biliary colic Acute and chronic cholecystitis Mucocoele Empyema Carcinoma Mirizzi syndrome
Complications of gallstones in bile ducts
Obstructive jaundice
Cholangitis
Pancreatitis
Complications of gallstones in the gut
Gallstone ileus
