Biliary Tract Disease Flashcards
Common biliary tract disease
Gallstones
Bile duct cancer
What are the symptoms gallstones
asymptomatic Colic Cholecystisis Jaundice pancreatitis bowel obstruction
Why do we get gall stones
Abnormal bile composition Bile stasis Infection Excess cholesterol Excess bilirubin
What does bile contain
Cholesterol
Bilirubin
Phospholipids
Potasium/sodium
Excess cholesterol/bilirubin can precipitate out into stones
Most common type of gallstones
Mixed - cholesterol and bilirubin
What are the risk factors for gallstones
Age >40 Female High fat diet Obesity Pregnancy Hyperlipidaemia Bile salt loss (Chrons) Diabetes Dysmotility of GB Prolonged fasting TPN
How are gallstones like putting sugar in tea
Not stirring sugar makes it sit at bottom of cup - lack of motility of GB makes cholesterol/bilirubin precipitate out into gallstones
Putting in too much sugar stops it dissolving - too much cholesterol/bilirubin causes stones
What causes a distended gallbladder
A gallstone blocking the common bile duct
What are the symptoms of biliary colic
Gall stone temporarily blocks cystic duct causes
Gradual build-up of pain in RUQ as pressure builds
Radiates to back/shoulder
May last 2-6 hours
associated with indigestion/nausea
Causes of severe acute epigastric pain
Biliary colic
Peptic ulcer disease
MI
Acute pancreatitis
What is acute cholecystitis
When the blocked cystic duct becomes infected
How to diagnose gallstones
Ultrasound
CT - to look for complications related to gallstones not actual gallstones
MRCP (like MRI) /ERCP
HIDA - nuclear medicine test looking at gallbladder motility
EUS -
What does sphincter of Odi problem cause and how is it found
HIDA scan
Causes cholestasis as bile can’t get through into the duodenum
What does a CT scan show
Sometimes pics up gall stones
Dilation of gallbladder
Treatment of acute cholecystitis
IV antibiotics and IV fluids Nil by mouth US to confirm diagnosis Urgent cholecystectomy (ASAP) Interval cholecystectomy - 6-8 weeks time after they've gone home and inflammation has settled
What is laparoscopic cholesctamy
Removal of the gallbladder laparoscopically
safe
bile duct injury 0.2-0.6%
Complications of gallstones
Jaundice
Cholangitis (inflammation of biliary tree)
Acute pancreatitis
How do gallstones cause jaundice
Gallstones block common bile duct
What is gallstone ileus
Obstruction of the bowel by gallstones - gallstone impacted in distal ileum
Symptoms of common bile duct pathology
Itch Nausea Anorexia Jaundice Abnormal LTFs
What is ERCP
Endoscopy and stone removal
How do gallstones cause acute pancreatitis
Gallstone gets stuck in the common duct
Pancreas also has secretions going into the common duct so causes back pressure on the pancreas
What is the main symptom of gallstone ileus
Gallstone moves down SB causing intermittent colic
What causes gallstone ileus
A fistula (abnormal connection between two hollow spaces) is formed between the gallbladder and the duodenum Gallstones pass into the small intestine Move down the SB causing intermittent colic and SBO
What is the treatment for gallstone ileus
Urgent laparotomy - SB enetotomy to remove stone
Interval cholecystectomy in 3 months
What is a cholangiocarcinoma
Carcinoma of the bile duct
Second most common hepatoobiliary cancer
How to patients with cholangiocarcinoma present
Usually late Jaundice (painless) Weight loss Anorexia Lethargy
Staging/assesment techniques for cholangiocarcinoma
Duplex ultrasound
Spiral CT, ECRP, PTC
MIR, MRCP, MRA
Where is a type 1 cholangiocarcinoma
Below the confluence of the biliary tree
Where is a type 2 cholangiocarcinoma
Confined to confluence of the biliary tree
Where is a type 3 a/bcholangiocarcoma
Extension from confluence into right/left hepatic duct
Where is a type 4 cholangiocarcinoma
Extension into both right and left hepatic ducts from the confluence
What is the treatment for cholangiocarcinoma
Surgical resection
