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General Surgery > Billiary Colic > Flashcards

Billiary Colic Flashcards

1
Q

What is biliary colic (pathogenesis)?

A

Occurs when a gallstone is transiently impacted in the cystic duct, no infection

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2
Q

What are the clinical features of biliary colic?

A
  • Severe dull pain in epigastrum or RUQ for minutes to hours, has a crescendo-decrescendo pattern
  • May present with chest pain
  • Nausea and vomiting
  • Often occurs at night or after fatty meal
  • Radiate to right shoulder or scapula
  • No peritoneal findings or systemic signs
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3
Q

What will you find on investigations for biliary colic (blood work)

A
  • Normal: CBC, lytes, LFT’s bilirubin, amylase/lipase
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4
Q

What imaging modality would you use to investigate biliary colic? What will you find on positive exam?

A

U/S

  • 95% specific for stones
  • gallbladder wall thickening >4mm, edema (double wall), gallbladder sludge, pericholecystic fluid and sonographic murphy’s sign seen with cholecystitis
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5
Q

What is the treatment for biliary colic?

A
  • Analgesia
  • Rehydration
  • Elective cholecystectomy
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6
Q

What are some risk factors for cholesterol (gallbladder) stone formation?

A
  • Obesity
  • Estrogen (multiparity, OCP)
  • Terminal ileal resection or disease (ex. Crohn’s)
  • Impaired gallbladder emptying
  • Rapid weight loss (biliary stasis and rapid cholesterol mobilization)
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7
Q

What are some risk factors for the formation of pigment stones (caclium bilirubinate)

A
  • Cirrhosis
  • Chronic hemolysis
  • Biliary stasis
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8
Q

Name 4 factors protective for gallstones

A

1) Statins
2) Vitamin C
3) Coffee
4) Exercise

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9
Q

What is an MRCP?

A

magnetic resonance cholangiopancreatography - MRI to evaluate biliary tract and pancreatic ducts

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10
Q

What is an ERCP?

A

Endoscopic retrograde cholangiopancreatography

- Scope going into biliary and pancreatic ducts is diagnostic and therapeutic

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11
Q

What is a HIDA scan?

A

hepatobiliary iminodiacetic acid scan
- nuc med scan where technetium 99 is injected and excreted in high concentrations into the bile allowing visualization of the biliary tree

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12
Q

What is PTC?

A

Per-cutaneous transhepatic cholangiography

- inject contrast into hepatic parenchyma and flouroscopy performed, used if ER/MR CP fails or is unavailable

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13
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder resulting from sustained gallstone impaction in the cystic duct or Hartmann’s pouch

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14
Q

What is Hartmann’s pouch?

A

An out-pouching at the junction of the neck of the gallbladder and the cystic duct. Gallstones commonly are stuck here.

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15
Q

Clinical signs of acute cholecystitis?

A
  • Often have a history of biliary colic
  • Severe constant (hours to days) epigastric or RUQ pain
  • Anorexia
  • Nausea/Vomit
  • Low grade fever (
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16
Q

What is Boa’s Sign?

A

Right subscapular pain

17
Q

Which organisms tend to be involved in infections secondary to cholecystitis?

A
  • E. coli (gram negative rod)
  • Klebsiella (gram -ve rod)
  • Enterococcus (gram positive cocci)
18
Q

Treatment for acute cholecystitis?

A
  • Admit, hydrate NPO
  • NG tube if persistent vomiting from ileus
  • Analgesia
  • Antibiotics (cefazolin for uncomplicated)
  • Cholecystectomy
19
Q

What is acalculous cholecystitis?

A

cholecystitis in the absence of stone, typically due to gallbladder ischemia or stasis

20
Q

What is choledocolithiasis?

A

Stones in the common bile duct

21
Q

In choledocolithiasis what is a primary stone? what is a secondary stone?

A

Primary - formed in the CBD (indicates bile duct pathology such as sclerosing cholangitis, stricture)
Secondary - Formed in the gallbladder (85% of US cases)

22
Q

What lab abnormalities will you see in Choledocolithiasis?

A

1) CBC - leukocytosis
2) Liver enzymes - AST, ALT elevated early in disease
3) Increase in bilirubin
4) ALP and GGT elevated later

23
Q

Treatment of choledocolithiasis?

A

If no evidence of cholangitis ERCP for stone extraction, possibly followed by cholecystectomy

24
Q

What is cholangitis?

A
  • Obstruction of the CBD leading to biliary stasis, bacterial overgrowth, suppuration and biliary sepsis. May be life threatening
25
Q

Which bacteria are often present in cholangitis (6)

A
  • E.coli (gram -)
  • Klebsiella (gram -)
  • Psuedomonas (gram -)
  • Enterococcus (gram +)
  • B. fragilis (gram - rod)
  • Proteus (gram - rod)
26
Q

What is charcot’s triad?

A

1) Fever
2) RUQ pain
3) Jaundice

27
Q

What is reynold’s pentad?

A

1) Fever
2) RUQ pain
3) Jaundice
4) Shock
5) Confusion

28
Q

What labs would you order if suspecting cholangitis

A
  • CBC - ^ WBC, L-shift
  • LFT - obstructive picture (increased ALP, GGT, conjugated bili, mild increase AST, ALT)
  • Lipase to rule out pancreatitis

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