Biliary Tract Disease

Question 1

What are components of bile?

Answer 1

Bile pigments from broken down Hb
Cholesterol
Phospholipids

Question 2

If concentration between different stones vary different stones form, what are 3 types of stone?

Answer 2

Pigment stones (<10%) – small, friable, irregular – haemolysis

Cholesterol stones – large, often solitary – age, obesity, female sex

Mixed stones - faceted (calcium salts, pigment and cholesterol)

Question 3

90% of stones are asymptomatic, what are risk factors for them becoming symptomatic?

Answer 3

smoking

Parity (giving birth)

Question 4

What is acute cholecystitis?

Answer 4

Follows stone or sludge impaction at the neck of the gallbladder. Causes inflammation

Question 5

How does acute cholecystitis present?

Answer 5

continuous epigastric or RUQ pain – referred to right shoulder

Vomitting
Fever
Peritonism
GB mass

Question 6

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?

Answer 6

Inflammatory component in acute cholecystitis (fever, WCC, local peritonism)
There is no inflammatory component in biliary colic

Question 7

If a gall stone moves into and obstructs the common bile duct what occurs?

Answer 7

Obstructive jaundice and cholangitis (inflammation of bile ducts)

Question 8

Murphy’s sign is indicative of acute cholecystitis, what is Murphy’s sign?

Answer 8

2 fingers over right upper quadrant
Ask to breath in
Inflamed gallbladder causes pain and arrest of inspiration

Question 9

Tests for acute cholecystitis?

Answer 9

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

Question 10

Treatment of acute cholecystitis

Answer 10

Nil by mouth
Pain relief 
IV fluids
Cefuroxime
Laparoscopic cholecystectomy – either acute or delayed – is treatment of choice

Question 11

What is chronic cholecystitis

How does it present

Answer 11

Chronic gallbladder inflammation +- colic

Flatulent dyspepsia

Question 12

What is flatulent dyspepsia?

Answer 12

Vague abdominal discomfort, distention, nausea, flatulence and fat intolerance

Question 13

What is colic?

Answer 13

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.

Question 14

Tests for chronic cholecystitis?

Answer 14

Ultrasound to image stones and assess CBD diameter

MRCP (magnetic resonance cholangiopancreatography)
to find CBD stones

Question 15

Treatment for chronic cholecystitis?

Answer 15

cholecystectomy

Question 16

What is biliary colic?

Answer 16

Pain due to a gall stone temporarily blocking the cystic duct or bile duct

(no inflammation)

Question 17

How does biliary colic present clinically?

Answer 17

RUQ pain radiates tot he back +- jaundice

Question 18

Treatment of biliary colic

Answer 18

Analgesia
Nill by mouth
Rehydrate
Elective cholecystectomy

Question 19

How does cholangitis (biliary tract inflammation) present?

Answer 19

RUQ pain, rigors, jaundice- Charcot’s triad

Question 20

How is cholangitis treated?

Answer 20

Cefuroxime and Metronidazole

Question 21

Complications of gallstones in gallbladder and cystic duct

Answer 21

Biliary colic
Acute and chronic cholecystitis
Mucocoele 
Empyema
Carcinoma 
Mirizzi syndrome

Question 22

Complications of gallstones in bile ducts

Answer 22

Obstructive jaundice
Cholangitis
Pancreatitis

Question 23

Complications of gallstones in the gut

Answer 23

Gallstone ileus