CBL_gallbladder disease Flashcards
How common gallbladder problems are in the UK?
- 1 in every 10 adults in the UK has Gallstones
- Only minority develop symptoms
- 80% of stones asymptomatic
- 20% develop symptoms or complication related to gallstones
Types of gallstones
Types of Gallstones:
–Cholesterol stones (80%)
–Pigment stones
–Mixed stones
Name parts of anatomy of bile duct
What causes gallstones
•Imbalance in the chemical make-up of bile inside gall bladder
–Bile contains too much cholesterol
–Bile contains too much bilirubin
–GB doesn’t empty
Bile components
- Bilirubin (by-product of haeme degradation)
- Cholesterol (kept soluble by bile salts and lecithin)
- Bile salts (cholic acid/chenodeoxycholic acid: mostly reabsorbed in terminal ileum)
- Lecithin (increase solubility of cholesterol)
- Inorganic salts (sodium bicarbonate to keep bile alkaline to neutralise gastric acid in duodenum)
- Water (97% of bile)
What’s the most common underlying cause of the stones:
- cholesterol
- pigment
- mixed
•Cholesterol
–Imbalance between bile salts/lecithin and cholesterol allows cholesterol to precipitate
•Pigment
–Due to excess circulating bile pigments (haemolytic anaemia)
•Mixed
–Same as cholesterol stone
Other factors contributing to gallstones formation (3)
Other factors
–Stasis (pregnancy)
–Obesity and hypercholesterolaemia
–Small bowel resection - imbalance of bile reabsorption
Causes of RUQ pain
- Gallstones disease (and its related complications)
- Gastritis/duodenitis
- Peptic ulcer disease/perforated peptic ulcer
- Acute pancreatitis
- Right Lower lobe pneumonia
- MI
What basic investigations a patient with RUQ pain should have
All patients should have
- Blood test
- X-rays
- ECG
Risk factors for gallstone disease
Gallstone disease
- F>M (2:1)
- Obesity (Fat, Female, Forty, Fair/white)
- Pregnancy
- Haemolytic anaemias (pigment stones)
- Genetic predisposition
What other diseases are gallstones associated with?
Associated with
- Crohn’s disease
- Diabetes
- Hypertriglyceridaemia
- partial gastrectomy
What are the two most common presentations of gallstones?
- Biliary colic is the most common presentation
- 2nd most common presentation is acute cholecystitis
What’s biliary colic?
Pain associated with passage of stone
(a stone tries to get through the muscular/smooth muscle tube)
Symptoms of biliary colic
- Sudden onset epigastrium or RUQ with radiates to Right shoulder or back
- Nausea or vomiting
- Sweaty
Characteristics of colicky pain - in terms of relief (time and reason)
- Typically colicky pain resolve after minutes to few hours
- Pain relieved when stone re-enters gallbladder or is passed through the duct into the small bowel
Management of biliary colic
- Usually resolve itself
- Analgesia
- Fluid if vomiting
- Anti-emetics
- Exclude acute cholecystitis
- Bloods: LFTs, FBC, U+Es
- Ultrasound
- Elective Cholecystectomy
What’s acute cholecystitis?
Causes of it
Acute Cholecystitis -> acute inflammation of the gallbladder
- Gallstone stuck in cystic duct
- Less commonly with biliary sludge/precipitate
- A-calculus (no stones) cholecystitis rare
- Bacterial infection in 50% only
Complications of acute cholecystitis
Complications of acute cholecystitis
–Empyema - collection of pus in the gallbladder
–septicaemia
–chronic cholecystitis
–perforation of gallbladder
What’s Murphy’s sign?
- disease associated with
- describe
Symptoms and signs of acute cholecystitis
- Sudden onset
- Post-prandial
- RUQ pain radiate to back
- Constant
- Associated with nausea and vomiting
- Recurrent attack common
- Pyrexia
- Murphy’s positive
- Jaundice – CBD stones or Mirrizi’s syndrome
What can be seen on USS for cholecystitis?
Gallstones, thickened gallbladder wall, pericholecystic fluids
Management/investigations for acute cholecystitis
- Need admission
- Analgesia, DVT prophylaxis
- Intravenous fluids
- Bloods
- Ultrasound to confirm diagnosis
- Gallstones, thickened gallbladder wall, pericholecystic fluids)
- Antibiotics
- Majority (95%) resolve with conservative treatment
- May require CT scan to exclude complication
- Empyema (percutaneous drainage)
- Gangrene/perforation (Emergency surgery)
USS for cholecystitis
Cause of gallstone pancreatitis?
Gallstone pancreatitis most common cause of pancreatitis as stone stuck in Ampulla of Vater
Acute cholangitis
- what’s that
- cause
- symptoms
Acute cholangitis : severe infection of biliary tree
Symptoms: fever, pain and jaundice
Cause: a stone in common bile duct or a stricture or after ERCP (1%)
What organisms may cause acute cholangitis?
- Usual bugs are Klebsiella, E.Coli, Enterococci, streptococci in UK
- parasites in other countries might be roundworm and liver fluke
What’s gallstone ileus?
How common is it?
Gallstone ileus due to bowel occlusion by gallstones
- rare about 2% of bowel obstruction
What’s Charcot’s Triad?
What’s Reynold’s pentad?
Charcot’s tirad: fever, jaundice, RUQ pain
Reynold’s pentad: fever, jaundice, RUQ pain, confusion, hypotension
Biliary colic
- history
- examination
- blood tests + results
Biliary colic