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Y1 GI > Biliary Tract Disease > Flashcards

Biliary Tract Disease Flashcards

1
Q

Common biliary tract disease

A

Gallstones

Bile duct cancer

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2
Q

What are the symptoms gallstones

A 
asymptomatic 
Colic
Cholecystisis 
Jaundice 
pancreatitis 
bowel obstruction
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3
Q

Why do we get gall stones

A 
Abnormal bile composition 
Bile stasis 
Infection 
Excess cholesterol 
Excess bilirubin
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4
Q

What does bile contain

A

Cholesterol
Bilirubin
Phospholipids
Potasium/sodium

Excess cholesterol/bilirubin can precipitate out into stones

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5
Q

Most common type of gallstones

A

Mixed - cholesterol and bilirubin

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6
Q

What are the risk factors for gallstones

A 
Age >40 
Female 
High fat diet 
Obesity 
Pregnancy 
Hyperlipidaemia 
Bile salt loss (Chrons) 
Diabetes 
Dysmotility of GB 
Prolonged fasting 
TPN
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7
Q

How are gallstones like putting sugar in tea

A

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

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8
Q

What causes a distended gallbladder

A

A gallstone blocking the common bile duct

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9
Q

What are the symptoms of biliary colic

A

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

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10
Q

Causes of severe acute epigastric pain

A

Biliary colic
Peptic ulcer disease
MI
Acute pancreatitis

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11
Q

What is acute cholecystitis

A

When the blocked cystic duct becomes infected

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12
Q

How to diagnose gallstones

A

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 -

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13
Q

What does sphincter of Odi problem cause and how is it found

A

HIDA scan

Causes cholestasis as bile can’t get through into the duodenum

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14
Q

What does a CT scan show

A

Sometimes pics up gall stones

Dilation of gallbladder

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15
Q

Treatment of acute cholecystitis

A 
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
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16
Q

What is laparoscopic cholesctamy

A

Removal of the gallbladder laparoscopically
safe
bile duct injury 0.2-0.6%

17
Q

Complications of gallstones

A

Jaundice
Cholangitis (inflammation of biliary tree)
Acute pancreatitis

18
Q

How do gallstones cause jaundice

A

Gallstones block common bile duct

19
Q

What is gallstone ileus

A

Obstruction of the bowel by gallstones - gallstone impacted in distal ileum

20
Q

Symptoms of common bile duct pathology

A 
Itch 
Nausea 
Anorexia 
Jaundice 
Abnormal LTFs
21
Q

What is ERCP

A

Endoscopy and stone removal

22
Q

How do gallstones cause acute pancreatitis

A

Gallstone gets stuck in the common duct

Pancreas also has secretions going into the common duct so causes back pressure on the pancreas

23
Q

What is the main symptom of gallstone ileus

A

Gallstone moves down SB causing intermittent colic

24
Q

What causes gallstone ileus

A 
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
25
Q

What is the treatment for gallstone ileus

A

Urgent laparotomy - SB enetotomy to remove stone

Interval cholecystectomy in 3 months

26
Q

What is a cholangiocarcinoma

A

Carcinoma of the bile duct

Second most common hepatoobiliary cancer

27
Q

How to patients with cholangiocarcinoma present

A 
Usually late
Jaundice (painless) 
Weight loss 
Anorexia 
Lethargy
28
Q

Staging/assesment techniques for cholangiocarcinoma

A

Duplex ultrasound
Spiral CT, ECRP, PTC
MIR, MRCP, MRA

29
Q

Where is a type 1 cholangiocarcinoma

A

Below the confluence of the biliary tree

30
Q

Where is a type 2 cholangiocarcinoma

A

Confined to confluence of the biliary tree

31
Q

Where is a type 3 a/bcholangiocarcoma

A

Extension from confluence into right/left hepatic duct

32
Q

Where is a type 4 cholangiocarcinoma

A

Extension into both right and left hepatic ducts from the confluence

33
Q

What is the treatment for cholangiocarcinoma

A

Surgical resection

Y1 GI (41 decks)

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