Biliary Tree Disease

Question 1

What is the correct term for gallstones?

Answer 1

Cholelithiasis

Question 2

What are the two types of gallstone? How are they formed?

Answer 2

Cholesterol - supersaturation/crystallisation

Pigment - bilirubin and calcium salts

Question 3

What’s the difference between brown and black gallstones?

Answer 3

Black - sterile site, radiopaque

Brown - infected site, radiotranslucent

Question 4

What is the main symptom of gallstones, if not clinically silent?

Answer 4

Biliary colic

Question 5

What are the treatment options for cholelithiasis?

Answer 5

Low fat and lose weight, laparoscopy, cholecystectomy, ursodeoxycholic acid

Question 6

What are the two main causes of cholecystitis?

Answer 6

Calculous - gallstones

Acalculous - severely ill, ischaemia of cystic artery

Question 7

Describe how symptomatic cholecystitis should be treated.

Answer 7

IV abx, fluids, nil by mouth

Question 8

How does chronic cholecystitis arise?

Answer 8

Low grade inflammation + gallstones

Question 9

What are the main complications of cholecystitis?

Answer 9

Superinfection, perforation, abscess, rupture with peritonitis

Question 10

What is the proposed cause of carcinoma of the biliary tree?

Answer 10

Gallstones -> chronic inflammation -> carcinoma

Question 11

What are the treatment options for carcinoma of the biliary tree?

Answer 11

Resection, chemotherapy + stents with ERC/PTC