Biliary Tract Disease Flashcards
What can gallstones cause?
Colic cholecystitis jaundice pancreatitis bowel obstruction
Why do gallstones form?
Abnormal bile composition Bile stasis Infection Excess Cholesterol Excess Bilirubin
What are the risk factors for developing gallstones?
Age > 40 Female High fat diet Obesity Pregnancy Hyperlipidaemia Bile salt loss (Crohn’s) Diabetes Dysmotility of GB Prolonged fasting TPN
Describe biliary colic?
Stone impacts in cystic duct Gradual build-up pain in RUQ Radiates to back / shoulder May last 2-6 hours Associated with indigestion / nausea
Describe Acute cholecystitis?
Inflammation in GB - Obstruction of Cystic duct
Initially Sterile, then becomes infected
How are gallstones diagnosed?
HISTORY Ultrasound - best CT scan – see surrounding organs MRCP / ERCP – find out where stone is HIDA – looks at gallbladder motility (radioactive tracer is given to patient) EUS
What is the treatment of acute cholecystitis?
IV antibiotics and IV fluids Nil by mouth Ultrasound to confirm diagnosis Urgent cholecystectomy (asap) Interval cholecystectomy
What are the complications of gallstones?
Jaundice
Cholangitis
Acute Pancreatitis
Gallstone Ileus
When would you perform an ERCP?
to remove stones
What are the complications of ERCP?
perforation
bleeding
pancreatitis
Describe acute pancreatitis?
Autodigestion of peri-pancreatic tissues by activated enzymes
Cholecystectomy during INDEX admission
ERCP / ES if frail
What is a Gallstone ileus?
Small bowel obstruction –
gallstone impacted in distal ileum
Fistula gallbladder + duodenum - Large gallstone passes into small intestine.
Moves down SB causing intermittent colic
Present with distal SB obstruction
What is the treatment of Gallstone ileuses?
Urgent Laparotomy – SB enterotomy to remove stone
Interval cholecystectomy in 3 months.
What is the common presentation of Cholangiocarcinoma?
Jaundice; Weight loss; anorexia; lethargy
50% lymph node metastases
20-30% peritoneal metastases at diagnosis
How are Cholangiocarcinomas diagnosed?
Duplex Ultrasound
(Spiral CT / ERCP / PTC)
MRI / MRCP/ MRA
