biliary tract diseases Flashcards
what are the three biliary tract diseases?
- biliary colic- gallstones
- cholecystitis
- Ascending cholangitis
what are the 5 risk factors for biliary tract diseases?
5 F’s
1. fat
2. female
3. forty
4. fair
5. fertile
define biliary colic
the pain associated with the temporary obstruction of the cystic or common bile duct by a stone migrating from the gall bladder
describe the pathology behind biliary tract disease
- Gallstones are small stones that form in the gall bladder
- they form from concentrated bile in the common bile duct/ cystic duct
- stones made of either
- cholesterol ( 80%)
-pigment
- mixture of both - can be asymptomatic or cause pain and complications
what are the symptoms of biliary tract disease?
-colicky RUQ pain worse after fatty meals
- nausea and vomiting
how are biliary tract diseases diagnosed?
FBC + CRP
LFTS- High ALP
AMYLASE ( pancreatitis)
Biliary colic: what is the firstline of diagnosis ? - what are you looking for?
do an abdo ultrasound
looking for:
- duct dilation
- stones
-gallbladder wall thickness
what is the treatment for biliary tract diseases?
- elective laparoscopic cholecystectomy if symptomatic
- mild pain- NSAIDS
- severe pain- IM DICLOFENAC
- analgesics
- lifestyle changes
define cholecystitis
redness and swelling ( inflammation) of the gallbladder
describe the pathology behind cholecystitis
- stone is blocking the duct
- bile builds up, distending the gall bladder
- decrease vascular supply
- transmural inflammation
what are the symptoms for cholecystitis?
- RUQ pain ( can radiate to right shoulder)
- fatigue
- fever
- tenderness and guarding
- positive Murphys sign
what does a positive Murphys sign mean?
- severe pain on deep inhalation with examiners hand pressed onto RUQ
how is cholecystitis diagnosed?
- abdo ultrasound
- FBC
- LFT
what would you find on an abdominal ultrasound for cholecystisits?
- thick gallbladder wall
-stones
-fuid around gall bladder
what would you find on an FBC for cholecystisits?
- leukocytes
- neuetrophilia
What would a LFT look like for cholecystisits?
- normal
how is cholecystitis treated?
- conservative management before surgery
- anti biotics IV, heavy analgesia, IV fluids - cholecystectomy- within 72 hours
what are the symptoms for ascending cholangitis?
- RUQ pain
- Fever
- jaundice- obstructive
- charcots triad
- Reynolds pentad
what does Reynolds pentad include?
charcots triad+ altered mental state+ hypotension
how is ascending cholangitis diagnosed?
- FBC
-LFT - abdominal ultrasound
- MRCP
in ascending cholangitis what would you find in FBC?
- leukocytes
- neuetrophilia
in ascending cholangitis what would you find in LFT?
increased conjugated hyperbilirubinaemia
in ascending cholangitis what would you find in an abdominal ultrasound?
CBD dilation and gall stones
in ascending cholangitis what would you find in MRCP?
DIAGNOSTIC
what is the treatment for ascending cholangitis?
ERCP
bile duct clearance
then laparoscopic cholecystectomy once stable
