Biliary Tract Disease Flashcards
what are the 2 main biliary tract diseases?
gallstones
biliary tract cancer
what are the symptoms of gallstones?
Most are asymptomatic colic cholecystitis jaundice pancreatitis bowel obstruction
what are the symptoms of gallstones?
Most are asymptomatic biliary colic cholecystitis jaundice pancreatitis bowel obstruction
what can cause gallstones?
abnormal bile composition bile stasis infection excess cholesterol excess bilirubin
what are the components of bile?
cholesterol
bilirubin
phospholipids
sodium and potassium
what type of gallstones are most common?
mixed (80%)
cholesterol (10%)
biliruvin (10%)
name some risk factors for gallstones?
fat female 40s or over fertile foetus (4 Fs) bile salt loss (crohns) diabetes dysmobility of GB prolonged fasting TPN (total parenteral nutrition)
how can gallstones cause a fistula?
continuous inflammation of the gall bladder wall (in close association to duodenum) can cause a fistula to form
what is bilary colic?
where 1 big stone gets stuck leaving the gall bladder
causes severe pain and spasm
how can a gallstone cause acute cholecystitis?
stone stuck in the neck causes obstruction
cause increased pressure on the walls
can cause distension, infection and sever pain
what does an air fluid level in gallbladder in XR suggest?
gas within the gallbladder - possible duodenal fistula
how can gallstones be diagnosed?
US (best, 1st line) CT scan (only to assess complications) MRCP/ERCP HIDA (nuclear test, looks at motility) EUS
how is acute cholecystitis treated?
IV antibiotics + IV fluids
nil by mouth
urgent or interval cholecystectomy
how is acute cholecystitis treated?
IV antibiotics + IV fluids
nil by mouth
urgent(2-5 days) or interval cholecystectomy (several weeks, inflammation died down)
what can occur when gallstones migrate into common bile duct?
jaundice
cholangitis
acute pancreatitis (gets stuck at ampulla where pancreatic duct joins)
what is gallstone ileus?
obstruction of the bowel by gallstone impacted in distal ileum
what are the symptoms of common bile duct pathology?
itch nausea anorexia jaundice abnormal LFTs
what is ERCP mainly used for, imaging or treatment?
treatment
removal of stones
what are the most common causes of pancreatitis?
alcohol
gallstones
how do gallstones cause acute pancreatitis?
obstruct ampulla of vater to pancreatic duct is blocked and enzymes back up into pancreas causing autodigestion of pancreas
how does gallstone ileus occur?
fistula between gallbladder and duodenum
gallstone passes into small intestine
Moves down small bowel causing intermittent colic
present with distal small bowel obstruction
how is gallstone ileus treated?
urgent laparotomy - small bowel enterectomy to remove stone
Interval cholecystectomy if needed
what is cholangiocarcinoma?
cancer of the bile duct
2nd most common hepatobiliary cancer
how does cholangiocarcinoma present?
jaundice (late sign - probably spread)
weight loss
anorexia
lethargy
how is cholangiocarcinoma staged?
duplex US
spiral CT/ERCP/PTC)
MRI/MRCP/MRA
what are the 4 types of cholangiocarcnoma?
I = just below hila II = confined to confluence of biliary tree IIIa = into right hepatic duct IIIb = into left hepatic duct IV = into right and left duct
what is the only chance of cure of cholangiocarcinoma?
surgical resection
how is cholangiocarcnoma treated palliatively?
biliary stent (ERC/PTC stent insertion)
