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
What is MRCP?
Magnetic resonance Cholangiopancreatography
What is ERCP?
Endoscopic Retrograde Cholangio-Pancreatography
What can you do in ERCP?
Remove any stones at the same time
What is acute pancreatitis?
Inflammation of the pancreas
What might acute pancreatitis be caused by?
GET SMASHED
Gallstone - 95%
Alcohol - common also
What symptoms and signs might you see in acute pancreatitis?
Severe epigastric pain radiating to the back
Fever, nausea, vommiting
Grey turners sign (flank bruising) Cullen’s signs (periumbilical bruising)
What is the treatment of gallstone ileus?
Urgent laparotomy - remove stone
Interval cholecystectomy in 3 months - the removal of a diseased gallbladder after drainage for acute infection
How are symptomatic gallstones treated?
Removal of the gallbladder - (laparoscopic cholecystectomy)
What is a biliary tumour?
Cholangiocarcinoma - 2nd most common hepatobiliary cancer
Where do you often find cholangiocarcinoma?
Intrahepatic
Extra hepatic
(upper 3rd 56%, middle 17%, lower 18-27%)
What is the clinical presentation of cholangiocarcinoma?
Usually late
Jaundice
Weight loss
Anorexia
Lethargy
(50% have lymph node metastases)
How might you stage/assese cholangiocarcinoma?
Duplex ultrasound
spiral CT/ERCP/PTC
(MRI/MRCP/MRA)
How do you treat cholangiocarcinoma?
Surgical resection is the only ‘cure’
What might be a palliative option for cholangiocarcinoma?
Biliary stand - ERC/PTC insertion
Survival 1-6months
