Biliary tree damage

Question 1

What two structure form the common bile duct?

Answer 1

Common hepatic duct
Cystic duct

Question 2

Complications of gallstones

Answer 2

Biliary colic
Acute cholecystitis
Acute ascending cholangitis
Acute pancreatitis

Question 3

What is biliary colic?

Answer 3

• sudden constant onset right upper quadrant pain (radiates to back)
• caused by temporary obstruction of cystic duct by gallstones at neck of gallbladder

Question 4

Treatment of biliary colic

Answer 4

Pain relief
Cholecystectomy (gallbladder removal)

Question 5

What is acute cholecystitis?

Answer 5

• inflammation of gallbladder
• due to impaction of gallstones in cystic duct
• right upper quadrant pain + fever
• Murphy’s sign

Question 6

Treatment of acute cholecystitis

Answer 6

Analgesia
Antibiotics
Cholecystectomy

Question 7

Risk factors for gallstones

Answer 7

5 Fs
- fat
- female
- forty
- fertile (pregnancy)
- family history

Question 8

What is Murphys sign?

Answer 8

• place hand on patients right side of abdomen
• ask to take a deep breath in
• gall bladder hits hand > patient sudden breath in and pain
• no pain on left side

Question 9

What is acute ascending cholangitis?

Answer 9

• infection of the biliary tree caused by gallstone blocking the common bile duct
• Charcot’s triad presentation: RUQ pain, fever/inflammation + jaundice

Question 10

What is acute pancreatitis?

Answer 10

• gallstone obstructs distal common bile duct where the pancreatic duct joins
• this causes premature activation of pancreas enzymes
• protease enzymes auto digest the pancreas
• epigastric pain (can radiate to back)

Question 11

Presentation of acute pancreatitis

Answer 11

Epigastric pain > radiates to back
Vomiting
Cullen’s sign
Grey Turner’s sign

Question 12

Management of acute pancreatitis

Answer 12

• Rule out other causes of Epigastric pain
• supportive care
• identify elevated enzymes in blood test (lipases, amylase)

Question 13

What is Cullen’s sign?

Answer 13

Superficial oedema + bruising in subcutaneous fatty tissue around umbilicus

Cullen - Central

Question 14

What is Grey Turner’s sign?

Answer 14

Bruising of the flanks

Question 15

Differentiate between the presentations of biliary colic, acute cholecystitis + acute ascending choangitis

Answer 15

• BC: RUQ pain
• AC: RUQ + fever/inflammation (+ Murphys sign)
• AAC: RUQ + fever/inflammation + jaundice

Question 16

What is the pain associated with gallstone called?

Answer 16

Biliary colic

Question 17

Why does biliary colic come on about an hour after food?

Answer 17

CCK is released during digestion

Question 18

Potential complications of stone lodging in proximal common bile duct

Answer 18

Cholangitis > post hepatic jaundice

Question 19

Potential complications of a stone lodging in the distal common bile duct

Answer 19

Acute pancreatitis

Question 20

Causes of acute pancreatitis

Answer 20

I GET SMASHED

• Idiopathic
• Gall stones
• Ethanol
• Trauma
• Scorpion stings
• Mumps
• Autoimmune
• Steroids
• Hypercalcaemia
• ERCP
• Drugs

Question 21

What can gallstones form from?

Answer 21

Cholesterol
Bile pigment
Both

Question 22

A gallstone stuck in the neck of gall bladder causes what?

Answer 22

Biliary colic

Question 23

A gallstone stuck in cystic duct causes what?

Answer 23

Cholecystitis

Question 24

A gallstone stuck in common bile duct causes what?

Answer 24

Ascending cholangitis

Question 25

What is Charot’s triad?

Answer 25

Fever
Jaundice
RUQ pain

Question 26

What causes biliary colic?

Answer 26

• CCK release by small intestine during digestion
• causes contraction of gallbladder > bile release
• gallstones irritate entrance to galbadder
• intermittent pain associated with eating

Question 27

What causes cholecystitis?

Answer 27

• gallstone stuck in cystic duct
• fluid statins inside gallbladder > inflammation + infection
• causes RUQ pain + fever