Biliary Tract Disease Flashcards
what are the symptoms of gall stones
most asymptomatic- colic, cholecystitis, jaundice, pancreatitis, bowel obstruction
what causes gall stones
abnormal bile consumption, bile stasis, infection,
excess cholesterol, excess bilirubin
what are the different types of gall stones
cholesterol, pigment, primary bile duct stones, mixed (cholesterol and bilirubin)
what are the risk factors for gallstones
the five F’s
age >40 female high fat diet + obesity pregnancy (fertile) hyperlipidaemia
crohns (bile salt loss) diabetes dysmotility of GB prolonged fasting TPN
where is bile absorbed
the terminal part of the ileum
what causes biliary colic
when a stone impacts in the cycstic duct
what are the characteristics of biliary colic
gradual build up of pain in RUQ, radiates to back/ shoulder, may last 2-6 hours, associated with indigestion/ nausea
what are the causes of severe acute epigastric pain
biliary colic, peptic ulcer disease, oesophageal spasm, myocardial infarction, acute pancreatitis
what is acute cholecystitis
inflammation of the GB, due to obstruction of the cystic duct. initially sterile then becomes infected
when is air present in the GB
not normally, air can come from duodenum or fistula or gas producing bacteria
are you expected to see stones on an x ray
no
what is the gold standard for diagnosing stones
ultrasound
what investigations can be done to diagnose gallstones
ultrasound, CT scan, MRCP/ERCP, HIDA, EUS
what is the positive of a CT in GS
looks at pancreas - can assess complications
what is an MRCP
MRI of biliary system
what is HIDA
nuclear medicine that looks at the motility of the gall bladder- measures ejection- less than 30% unhealthy. also measures the sphincter of oddi and gut function
what is the treatment of acute cholecystitis
IV antibiotics and fluid
urgent cholecystectomy
interval cholecystectomy (removal after 6-12 weeks)
What are the complications of gall stones
might migrate to CBD, gallstone ileus
what happens when gallstones migrate to the CBD
jaundice, cholagitis, acute pancreatitis
what are the presentations of common bile duct pathologies
itch, nausea, anorexia, jaundice, abnormal LFTs
what is an ERCP
endoscope + stone removal
what suggests there is a stone in the CBD
dilated bile duct with deranged LFTs
what can cause acute pancreatitis
i get smashed
I- idiopathic
g-GS
e-ethanol
t-trauma
s-steroids m-mumps (infections)/ malignancy a-autoimmune s-scorpion stings/ spider bites h-hyperlipidaemia/ hypercalcaemia/ hyperparathyroidism (metabolic disorders) E-ERCP d-drugs
what does acute pancreatitis cause
autodigestion of peri-pancreatic tissues by activated enzymes
how is acute pancreatitis treated
rehydration, cholecystectomy, ERCP/ endoscope
what is a gallstone ileus
small bowel obstruction due to impacted gallstone in distal ileum
when can a large gallstone pass into small intestine
fistula that allows gallstone to pass into duodenum
what does a gallstone do as it moves down the small bowel
causes intermittent colic
how do gall stone ileus present
with distal small bowel obstruction
what is the treatment for a gallstone ileus
urgent laparotomy (SB enetrotomy to remove stone), interval cholecystecomy in 3 months
what is cholangiocarcinoma
cancer in the bile duct, 2nd most common hepatocelullar cancer
how do cholangiocancinomas present
jaundice, weight loss, anorexia, lethargy
50% lymph node metastases, 20-30% peritoneal metastases
how is cholangiocarcioma stages
duplex ultrasound, spiral CT/ ERCP/ PTC),
MRI/MRCP/MRA
how are hilar cholangiocarcinomas classified
on how far they extend past the confluence and into the right and left hepatic ducts
what is the only chance of cure of cholangiocarcinoma
surgical resection of bile duct and liver
what are the palliation options for cholangiocarcinoma
biliary stent, ERc/PTC insertion
what is an ERC
endoscopic retrograde cholangiography
what is a PTC
Percutaneous transhepatic cholangiography (same as PTHC)
