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Liver > Biliary Tract Disease > Flashcards

Biliary Tract Disease Flashcards

1
Q

What is biliary colic?

A

Pain associated with the temporary obstruction of the cystic or common bile duct by a stone migrating from the gallbladder

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2
Q

What is cholecystitis?

A

Gallbladder inflammation

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3
Q

What are the two types of gallstones?

A
  • Cholesterol gallstone

- Bile pigment stones

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4
Q

What are the complications of a gallstone located in the gallbladder and the cystic duct?

A
  • Biliary colic
  • Acute cholecystitis
  • Empyema - gallbladder filling with pis
  • Carcinoma
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5
Q

What are the complications of a gallstone lodged in the bile ducts?

A
  • Obstructive jaundice
  • Cholangitis - inflammation of the bile duct
  • Pancreatitis
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6
Q

What are the main causes of gallstones?

A
  • Obesity and rapid weight loss
  • Diabetes
  • OCP
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7
Q

How is a cholesterol stone formed?

A
  • Cholesterol comes out of solution held by bile salts and phospholipids and crystallises to form stones
  • Due to either excess cholesterol or decrease in bile salts
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8
Q

How are bile pigmented stones formed?

A
  • Haemolysis leads to excess bilirubin - which binds to calcium to form black pigmented stones
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9
Q

What are brown pigmented stones?

A
  • Usually and infected stone caused as a result of biliary stasis
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10
Q

What is ascending cholangitis?

A

Bile duct inflammation as a result of CBD obstruction

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11
Q

What are the risk factors for ascending cholangitis?

A
  • Female
  • Obesity
  • Fatty foods
  • Fertile
  • Smoking
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12
Q

What is the nature of biliary colic pain?

A
  • Sudden onset
  • Severe
  • Crescendo
  • RUQ
  • Radiation may go to shoulder
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13
Q

What is charcots triad presentation in ascending cholangitis?

A
  1. Fever
  2. Biliary colic
  3. Jaundice
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14
Q

Describe the differences in the presentation between Biliary colic, Acute cholecystitis and Ascending cholangitis ?

A

RUQ Fever Jaundice
Biliary colic yes no no
Acute cholecystitis yes yes no
Ascending cholangitis yes yes yes

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15
Q

What investigations would you do in someone with biliary colic?

A

Abdominal ultrasound is the most useful for diagnosing gallstone disease? But colic itself is unlikely to be associated with any significant abnormality in tests §

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16
Q

What would you see on the blood test in acute cholecystitis?

A
  • Raise WCC and CRP

- raised serum bilirubin, APT and ATL levels

17
Q

What would you see on the abdominal ultrasound in someone with acute cholecystitis?

A
  • Think walled, shrunken gallbladder
  • Pericholecystic fluid
  • Stones
18
Q

What examination would you do in suspected acute cholecystitis?

A
  • RUQ tenderness

- Murphys sign

19
Q

What would you see on the blood tests in someone with ascending cholangitis?

A
  • Elevated neutrophil count
  • Raised ESR and CRP
  • Raised bilirubin - if bile duct obstruction is high
  • Raised serum alkaline phosphatase
  • Amino transferase levels are elevated
20
Q

What would you see on a transabdominal ultrasound in someone with ascending cholangitis?

A
  • Dilation of CBD
  • May or may not show cause of obstruction
    Distal CBD stones are easily missed
21
Q

What would you seen magnetic resonance cholangiography in someone with ascending cholangitis?

A

Clearly shows biliary treat so you can detect CBD stones

22
Q

What is the complication with a gallstone moving to the CBD?

A

Obstructive jaundice as bilirubin is backed up into the liver and leaks out into the blood

23
Q

What is the treatment for symptomatic gallbladder stones?

A

Laparoscopic cholecystectomy

24
Q

What is the pharmacological treatment for gallstones?

A
  • Analgesia
  • IV antibiotics
  • Cholecystectomy
25
Q

What can you do specifically for cholesterol stones?

A
  • Give oral ursodeoxycholic or cholesterol lowering agents to increased bile salt content of bile
26
Q

What is the name of the treatment that can be given to turn the stones into fragments so that they can be passed?

A

Shock wave lithotripsy

27
Q

What is the treatment for ascending cholangitis?

A
  • IV antibiotic
  • Urgent biliary drainage using ERCP
  • Surgery required to remove large stones

Liver (6 decks)

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