Biliary Tract Disease, Pancreatitis, Kidney Stone

Question 1

Describe acute cholecystitis. What is the most common cause?

Answer 1

Inflammation of the biliary tract wall due to chemical damage due to concentrated bile (phospholipase breaks down mucous layer) which is promoted by obstruction by stones(90%)

Bacterial superinfection may supervene (once wall is damaged).

Question 2

Describe the appearance and makeup of gallstones.

Answer 2

Made of cholesterol, bile brekadown pigment or both.

Cholesterol stones are pale.

Pigment stones are dark.

Question 3

Describe the clinical presentation of acute cholecystitis.

Answer 3

• Sudden onset RUQ pain which radiates to back close to the tip of right scapula.
• Pain is continuous and exacerbated by movemnet and respiration.
• Nausea and vomiting
• Murphy’s sign

Question 4

What is Murphy’s sign?

Answer 4

Pressure over gall bladder whilst patient is taking a deep breath will cause the patient to catch their breath at the point of maximum inhalation. The test is only positive if the same test in the LUQ does not cause pain.

Question 5

What is the clinical presentation of gallstone/biliary colic?

Answer 5

• Generalised severe upper abdominal pain
• Not true colic because it does not remit between exacerbations
• Nausea and vomiting

Question 6

What are the causes of pancreatitis?

Answer 6

Autoattack due to inappropriate release of enzymes - extent and severity of features depend on duration and degree of enzyme action.

Question 7

How do you get fat necrosis in acute pancreatitis?

Answer 7

Lipases attack fat locally which leads to fat necrosis

(In acute inflammation there is also leakage of fluid from blood vessels)

Question 8

Describe the clinical presentation of pancreatitis.

Answer 8

• Epigastric pain increasing in severity
• Patient lies still and breathes shallowly
• Radiates through to the back
• Sitting forward may relieve the pain
• Frequent vomiting and retching

Question 9

Describe the composition of kidney stones.

Answer 9

70% contain calcium (oxalate and phosphate) therefore seen in X Rays

Also uric acid and cysteine stones

Question 10

What types of kidney stones are most hazardous?

Answer 10

Small stones because they may pass into ureters.

Big stones never leave the kidneys therefore they are less hazardous

Question 11

Describe the clinical presentation of renal stones.

Answer 11

• Kidney stones cause excruciating loin pain
• Ureteric stones cause ureteric colic, classically radiating from the loin to the groin
• Associated nausea and vomiting
• Bladder or urethral stones cause pain on micturition and interrupt urine flow
• Microscopic haematuria