Biliary tree damage Flashcards
What two structure form the common bile duct?
Common hepatic duct
Cystic duct
Complications of gallstones
Biliary colic
Acute cholecystitis
Acute ascending cholangitis
Acute pancreatitis
What is biliary colic?
- sudden constant onset right upper quadrant pain (radiates to back)
- caused by temporary obstruction of cystic duct by gallstones at neck of gallbladder
Treatment of biliary colic
Pain relief
Cholecystectomy (gallbladder removal)
What is acute cholecystitis?
- inflammation of gallbladder
- due to impaction of gallstones in cystic duct
- right upper quadrant pain + fever
- Murphy’s sign
Treatment of acute cholecystitis
Analgesia
Antibiotics
Cholecystectomy
Risk factors for gallstones
5 Fs
- fat
- female
- forty
- fertile (pregnancy)
- family history
What is Murphys sign?
- 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
What is acute ascending cholangitis?
- infection of the biliary tree caused by gallstone blocking the common bile duct
- Charcot’s triad presentation: RUQ pain, fever/inflammation + jaundice
What is acute pancreatitis?
- 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)
Presentation of acute pancreatitis
Epigastric pain > radiates to back
Vomiting
Cullen’s sign
Grey Turner’s sign
Management of acute pancreatitis
- Rule out other causes of Epigastric pain
- supportive care
- identify elevated enzymes in blood test (lipases, amylase)
What is Cullen’s sign?
Superficial oedema + bruising in subcutaneous fatty tissue around umbilicus
Cullen - Central
What is Grey Turner’s sign?
Bruising of the flanks
Differentiate between the presentations of biliary colic, acute cholecystitis + acute ascending choangitis
- BC: RUQ pain
- AC: RUQ + fever/inflammation (+ Murphys sign)
- AAC: RUQ + fever/inflammation + jaundice
What is the pain associated with gallstone called?
Biliary colic
Why does biliary colic come on about an hour after food?
CCK is released during digestion
Potential complications of stone lodging in proximal common bile duct
Cholangitis > post hepatic jaundice
Potential complications of a stone lodging in the distal common bile duct
Acute pancreatitis
Causes of acute pancreatitis
I GET SMASHED
- Idiopathic
- Gall stones
- Ethanol
- Trauma
- Scorpion stings
- Mumps
- Autoimmune
- Steroids
- Hypercalcaemia
- ERCP
- Drugs
What can gallstones form from?
Cholesterol
Bile pigment
Both
A gallstone stuck in the neck of gall bladder causes what?
Biliary colic
A gallstone stuck in cystic duct causes what?
Cholecystitis
A gallstone stuck in common bile duct causes what?
Ascending cholangitis
What is Charot’s triad?
Fever
Jaundice
RUQ pain
What causes biliary colic?
- CCK release by small intestine during digestion
- causes contraction of gallbladder > bile release
- gallstones irritate entrance to galbadder
- intermittent pain associated with eating
What causes cholecystitis?
- gallstone stuck in cystic duct
- fluid statins inside gallbladder > inflammation + infection
- causes RUQ pain + fever
