Biliary Tract Disease

Question 1

What are the risk factors for gall stones?

Answer 1

age >40
Female
High fat diet
Obesity
Pregnancy
(Five Fs: fat, fertile, fourty, female, fair)
Hyperlipidaemia
Crohn's
Fasting
TPN

Question 2

Types of gall stones?

Answer 2

mixed
cholesterol
pigment (black)

Question 3

What are the symptoms of biliary obstruction by gall stones?

Answer 3

Billiary colic

• R upper quadrant pain
• radiates to the back and R shoulder

Question 4

What are good imaging tests for gall stones?

Answer 4

Ultrasound
MRCP (Magnetic resonance cholangiopancreatography)

CT is not great

Question 5

What is the Treatment of biliary colic?

Answer 5

• pain killers
• low fat diet
• weight loss
• surgery (cholecystectomy) if symptoms persist after 6 months
• Dissolve stones with Ursodeoxychoic acid if unfit for surgery

Question 6

What is acute cholecystitis?

Answer 6

Inflammation of the gall bladder

Question 7

How are gall stones removed from the bile duct?

Answer 7

ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

Question 8

What is gall stone pancreatitis?

Answer 8

Obstruction of the Ampulla of Vater, eading to back flow through the pancreatic duct.

Question 9

How is gall stone pancreatitis treated?

Answer 9

• ERCP gall stone removal (endoscopic sphincterotomy - open up sphincter of Oddi)
• Cholecystectomy - prevent further stone formation

Question 10

What is gallstone ileus?

Answer 10

Small bladder obstruction caused by a gallstone in the distal ileum.
-a large gallstone passes through a fistula between the gall bladder and the duodenum