biliary tract diseases

Question 1

what are the three biliary tract diseases?

Answer 1

1. biliary colic- gallstones
2. cholecystitis
3. Ascending cholangitis

Question 2

what are the 5 risk factors for biliary tract diseases?

Answer 2

5 F’s
1. fat
2. female
3. forty
4. fair
5. fertile

Question 3

define biliary colic

Answer 3

the pain associated with the temporary obstruction of the cystic or common bile duct by a stone migrating from the gall bladder

Question 4

describe the pathology behind biliary tract disease

Answer 4

1. Gallstones are small stones that form in the gall bladder
2. they form from concentrated bile in the common bile duct/ cystic duct
3. stones made of either
   - cholesterol ( 80%)
   -pigment
   - mixture of both
4. can be asymptomatic or cause pain and complications

Question 5

what are the symptoms of biliary tract disease?

Answer 5

-colicky RUQ pain worse after fatty meals
- nausea and vomiting

Question 6

how are biliary tract diseases diagnosed?

Answer 6

FBC + CRP
LFTS- High ALP
AMYLASE ( pancreatitis)

Question 7

Biliary colic: what is the firstline of diagnosis ? - what are you looking for?

Answer 7

do an abdo ultrasound
looking for:
- duct dilation
- stones
-gallbladder wall thickness

Question 8

what is the treatment for biliary tract diseases?

Answer 8

• elective laparoscopic cholecystectomy if symptomatic
• mild pain- NSAIDS
• severe pain- IM DICLOFENAC
• analgesics
• lifestyle changes

Question 9

define cholecystitis

Answer 9

redness and swelling ( inflammation) of the gallbladder

Question 10

describe the pathology behind cholecystitis

Answer 10

1. stone is blocking the duct
2. bile builds up, distending the gall bladder
3. decrease vascular supply
4. transmural inflammation

Question 11

what are the symptoms for cholecystitis?

Answer 11

• RUQ pain ( can radiate to right shoulder)
• fatigue
• fever
• tenderness and guarding
• positive Murphys sign

Question 12

what does a positive Murphys sign mean?

Answer 12

• severe pain on deep inhalation with examiners hand pressed onto RUQ

Question 13

how is cholecystitis diagnosed?

Answer 13

1. abdo ultrasound
2. FBC
3. LFT

Question 14

what would you find on an abdominal ultrasound for cholecystisits?

Answer 14

• thick gallbladder wall
  -stones
  -fuid around gall bladder

Question 15

what would you find on an FBC for cholecystisits?

Answer 15

• leukocytes
• neuetrophilia

Question 16

What would a LFT look like for cholecystisits?

Answer 16

• normal

Question 17

how is cholecystitis treated?

Answer 17

1. conservative management before surgery
   - anti biotics IV, heavy analgesia, IV fluids
2. cholecystectomy- within 72 hours

Question 18

what are the symptoms for ascending cholangitis?

Answer 18

• RUQ pain
• Fever
• jaundice- obstructive
• charcots triad
• Reynolds pentad

Question 19

what does Reynolds pentad include?

Answer 19

charcots triad+ altered mental state+ hypotension

Question 20

how is ascending cholangitis diagnosed?

Answer 20

• FBC
  -LFT
• abdominal ultrasound
• MRCP

Question 21

in ascending cholangitis what would you find in FBC?

Answer 21

• leukocytes
• neuetrophilia

Question 22

in ascending cholangitis what would you find in LFT?

Answer 22

increased conjugated hyperbilirubinaemia

Question 23

in ascending cholangitis what would you find in an abdominal ultrasound?

Answer 23

CBD dilation and gall stones

Question 24

in ascending cholangitis what would you find in MRCP?

Answer 24

DIAGNOSTIC

Question 25

what is the treatment for ascending cholangitis?

Answer 25

ERCP
bile duct clearance
then laparoscopic cholecystectomy once stable