Biliary tract disease (primary cirrhosis & colic) - hepatobilliary

Question 1

What is Acute cholecystitis?

Answer 1

• concentrated bile (phospholipase breaks down mucous layer)–> chemical damage –> Inflammation of wall of gallbladder
  
  • promoted by obstruction by stones (90% of cases)

Question 2

What can occur once the gallbladder wall is damaged?

Answer 2

Bacterial superinfection may intervene

superinfection = infection occuring on top of a previous infection

Question 3

What is a gallstone composed of?

Answer 3

• • Cholesterol.
• • Pigment (from bile break down pigment).
• • Mixed (most stones are mixed)
  
  • •Cholesterol: pale
  • • Pigment: dark

Question 4

What is Murphy’s sign?

Answer 4

pressure over the gall bladder whilst the 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 Acute cholecystitis?

Answer 5

• Sudden onset right upper quadrant pain which radiates through to the back close to the tip of the right scapula
• Continuous pain exacerbated by movement and respiration
• Nausea and vomiting
• positive Murphy’s sign

Question 7

What is the clinical presentation of Gallstone/Biliary colic?

Answer 7

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