Biliary Tree

Question 1

List 4 complications of Gallstones within the Gallbladder.

Answer 1

Biliary colic
Acute cholecystitis
Mucocele
Empyema

Question 2

Whats the Clinical scenario of biliary colic?

Answer 2

RUQ occurring 30 minutes after fatty foods with periods of exacerbation a against constant background pain. Radiation to subscapular area and lasts <4 hours

Question 3

Whats the Clinical scenario of acute cholecystitis?

Answer 3

RUQ pain, lasting >4 hours, constant severe associated with fever , nausea/vomiting, radiation to subscapular area and +ve Murphy’s sign.

Question 4

Whats the Clinical scenario of mucocele?

Answer 4

RUQ pain >4 hours , no fever

Question 5

Whats the Clinical scenario of Empyema?

Answer 5

RUQ pain, lasting >4 hours constant severe high fever chills rigors

Question 6

List 4 complications of Gallstones outside of the gallbladder.

Answer 6

Obstructive jaundice
Ascending cholangitis
Gallstone pancreatitis
Strictures

Question 7

2 line statement on the function of the gallbladder.

Answer 7

The Gallbladder is a muscular structure responsible for the concentration of Bile

Responsible for the storage of bile

Question 8

Why do gallstones form?

Answer 8

Admirand and small triangle

A)low bile salts concentration

B) low phospholipids concentration

C) High cholesterol concentration

Question 9

Management of a patient with acute cholecystitis.

Answer 9

• Resuscitate patient, establish IV access and give fluids if necessary
• CBC, WBC, LFT, RFT
• USS of gallbladder
• NG tube and NPO
• IV maintenance fluids
• Analgesics (morphine IV 0.1mg/kg)
• Antibiotics ( Ciprofloxacin and metronidazole)
• Pre op ECG and Chest X-ray
• Book for early Laparoscopic cholecystectomy

Question 10

What organisms are implicated in cholecystitis?

Answer 10

E. Coli
Klebsiella
Enterococcus
Pseudomonas 
Bacteroides fragilis

Question 11

Meds that can take care of gallstones

Answer 11

Ursodeoxycholic acid (ursodiol)

Urso= Polar bear

Question 12

Acalculous cholecystitis causes

Answer 12

Sepsis
Prolonged stay in ICU
TPN
Trauma
Burns

Question 13

Pneumobiliary causes (air in biliary tree)

Answer 13

ERCP
Fistula-gallstone ileus
T tube
Emohysematous cholangitis

Question 14

Charcot’s triad and Reynolds Pentad for cholangitis

Answer 14

Charcot: fever, jaundice, RUQ pain

Reynold: charcot triad + hypotension, altered mental state