Biliary Tract disease Flashcards
What is cholestasis?
Obstruction of bile flow out of the liver
What is cholecystitis?
Inflammation of the gallbladder - usually due to gallstones
What is cholangitis?
Infection of the bile duct
Why do we get gallstones?
Abnormal bile composition
Bile stasis
Infection
Excess cholesterol
Excess bilirubin
What are the different types of stones you can get?
Cholesterol stone
Pigment stone
Mixed stones - most common
Primary bile duct stones (rare)
What are the risk factors for gallstones?
5F’s
Female Forty Fat/high fat diet Foetus Fair
Hyperlipidaemia
Bile salt loss (crohns)
Diabetes
Prolonged fasting
Describe the pain and relief of pain?
Get pain due to spasm when the stone is in the cystic/bile duct
Relief of spasm = relief of pain
Describe biliary colic in gallstones?
Stone impacts in the cystic duct Gradual build up pain in RUQ Radiates to back/shoulder May last 2-6hrs Associated with indigestion/nausea
What are some differentials for severe acute epigastric pain?
Biliary colic Peptic ulcer disease Oesophageal spasm MI Acute pancreatitis
Describe acute cholecystitis?
Infection of the gallbladder - obstruction of the cystic duct
(RUQ pain and Fever)
Initially sterile, then becomes infected
Gallbladder can become dissented (due to increased intraluminal pressure in the gallbladder)
How do you diagnose gallstones?
Ultrasound CT scan MRCP/ERCP HIDA EUS
What is the treatment for acute cholecystitis?
IV antibiotics and IV fluids
Nil by mouth
US to conform
Urgen cholecystectomy
What might be some complications of gallstones?
Stones might migrate into CBD - jaundice, cholangitis, acute pancreatitis
Gallstone ileus
What is gallstone ileus?
When the stone erodes thought the GB into the duodenum - it may then obstruct the terminal ileum
Small bowel obstruction - gallstone impacted in distal ileum
Causes intermitted colic as it passes through SB
When do you get jaundice?
When there is a stone in the bile duct blocking the flow of bile
