Biliary Tract Disease Flashcards
symptoms of gallstones
most asymptomatic
signs of gallstones
biliary colic cholecystitis jaundice pancreatitis bowel obstruction
epidemiology of gallstones
incidence increases with age (>40)
woman >men
risk factors for gallstones
high fat diet obesity pregnancy hyperlipidaemia bile salt loss- Crohn's diabetes dysmotility of gallbladder prolonged fasting total Parenteral Nutrition
causes of gallstones
abnormal bile composition bile stasis infection excess cholesterol excess bilirubin
types of gallstones
mixed 80%
cholesterol
pigment
primary bile duct stones (rare)
why does patient get biliary colic pain
stone impacts in cystic duct
associated with indigestion/nausea
where is pain felt in biliary colic pain
gradual build-pain in right upper quadrant
last 2-6 hours
radiation of pain in biliary colic pain
back/shoulder
causes of severe acute epigastric pain
biliary colic peptic ulcer disease oesophageal spasm MI acute pancreatitis
tests for gallstones
ultrasound CT MRCO/ERCP HIDA EUS
treatment for biliary colic
pain killers
low fat diet
weight loss (if obese)
observe 3-6 months
treatment for recurrent episodes of pain/biliary colic
surgery - cholecystectomy (laparoscopic preferred)
treatment for unfit patient experiencing biliary colic
ursodeoxycholic acid
what is acute cholecystitis
inflammation in gallbladder - obstruction of cyst duct
initially sterile, then becomes infected
treatment for acute cholecystitis
IV antibiotics
IV fluid
nil by mouth
urgent cholecystectomy
tests for acute cholecystitis
ultrasound
ERCP (also removes stones)
complications of gallstones
stone may migrate into common bile duct
gallstone ileus
consequences of stone blocking cystic bile duct
jaundice
cholangitis
acute pancreatitis
signs of pathology in common bile duct
itch nausea anorexia jaundice abnormal LFTs
causes of acute pancreatitis
alcohol
gallstones
treatment for acute pancreatitis
cholecystectomy
ERCP/ES - if fail
what is gallstone ileum
small bowel obstruction
pathology of gallstone ileus
fistula gallbladder and duodenum - large gallstone passes into small intestine and moves down small bowel causing intermittent colic
treatment for gallstone ileus
urgent laparotomy
interval cholecystectomy
cholangiocarcinoma
second most common hepatobiliary cancer
clinical presentation of cholangiocarcinoma
jaundice
weight loss
anorexia
lethargy
staging of cholangiocaricnoma
duplex ultrasound
spiral CT/ERCP/PTC!!
MRI/MRCP/MRA
treatment for cholangiocarcinoma
surgical resection
biliary stent - ERC/PTC insertion
