Biliary Tract Disease

Question 1

What are the main risk factors for the development of gallstones?

Answer 1

• Age > 40
• Female
• High fat diet/ Obesity/ Hyperlipidaemia
• Pregnancy
• Bile salt loss (Crohn’s)
• Diabetes
• Dysmotility of Gall Bladder
• Prolonged fasting
• Total Parenteral Nutrition

Question 2

What causes the symptoms of biliary colic?

Answer 2

• Stone impacts in cystic duct
• Gradual build-up pain in RUQ
• Radiates to back / shoulder
• Lasts 2-6 hours
• Assoc. with indigestion / nausea

Question 3

What are the differential diagnoses for severe acute epigastric pain?

Answer 3

• Biliary colic
• Peptic ulcer disease
• Oesophageal spasm
• Myocardial infarction
• Acute pancreatitis

Question 4

How can gallstones be diagnosed?

Answer 4

Imaging

• US
• CT
• MRCP / ERCP

Question 5

How is biliary colic treated?

Answer 5

• Pain killers
• Low fat diet / lose weight if obese
• Observe for 3-6 months
• If Recurrent episodes pain / colic
  => Consider surgery
• If unfit for surgery
  => Ursodeoxycholic acid

Question 6

What is meant by acute cholecystitis?

Answer 6

• Gall bladder Inflammation
• Obstruction of Cystic duct
• Initially Sterile, then becomes infected

Question 7

How is acute cholecystitis treated?

Answer 7

• IV antibiotics and IV fluids
• Nil by mouth
• US to confirm diagnosis
• may need urgent cholecystectomy

Question 8

How is pathology of the common bile duct usually diagnosed?

Answer 8

• Pt presents with jaundice, Itch, nausea, anorexia

- Bloods show abnormal LFTs

Question 9

How do gallstones cause acute pancreatitis?

Answer 9

• stone blocks common bile duct
  => bile backs up into pancreas and causes inflammation
• need cholecystectomy or ERCP if frail pt

Question 10

What is a gallstone ileus?

Answer 10

• fistula between gallbladder + duodenum allows large gallstone to pass into small bowel
• Stone moves down small bowel causing intermittent colic
• Pt presents with distal Small bowel (ileum) obstruction

Question 11

How is gallstone ileus treated?

Answer 11

• Urgent Laparotomy to remove stone

- Interval cholecystectomy in 3 months.

Question 12

What is the best single test for the visualisation of gallstones?

Answer 12

US

Question 13

Where do most cholangiocarcinomas arise?

Answer 13

50-60% arise in perhilar area of bile ducts

• a minority arise in the bile ducts which are found IN THE LIVER (i.e. intrahepatic)

Question 14

Patient’s with cholangiocarcinoma usually present late. TRUE/FALSE?

Answer 14

TRUE
- symptoms are non-specific (anorexia/lethargy/jaundice)

• 50% present with lymph node metastases
• 20-30% have peritoneal metastases at diagnosis

Question 15

What methods of imaging are used to stage cholangiocarcinoma?

Answer 15

1) Duplex Ultrasound
2) Spiral CT / ERCP / PTC
3) MRI / MRCP/ MRA

Question 16

What palliative treatment can be used for patients with cholangiocarcinoma?

Answer 16

• Biliary Stent