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#Phase 2.1: Peri Op > Cholecystitis > Flashcards

Cholecystitis Flashcards

1
Q

What is cholecystitis?

A

Inflamm of gall bladder, secondary to gall stones

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2
Q

What are the components of bile? (3 things)

A
  1. Cholesterol
  2. Bile pigments (from broken down Hb)
  3. Phospholipids
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3
Q

What causes gall stones to form?

A

Change in concentration of the 3 bile components

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4
Q

How do Pigment stones form?

A

Haemolysis (increased Bile pigments)

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5
Q

What are the characteristics of Pigment stones? (3 things)

A
  1. Small
  2. Irregular
  3. Friable
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6
Q

How do Cholesterol stones form?

A
  1. High cholesterol (obv)
  2. Reduced bile salts
  3. Reduced lecithin

(Admirand’s triangle)

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7
Q

What increases the risk of Cholesterol stones to form?

A
  1. Female
  2. Age
  3. Obesity
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8
Q

What are the characteristics of Cholesterol stones? (2 things)

A
  1. Large

2. Often solitary

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9
Q

What are Mixed stones made up of?

A
  1. Calcium salts
  2. Pigment
  3. Cholesterol
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10
Q

What groups of people are Pigment stones more commonly seen in?

Why

A

Ppl with haemolytic anaemia

Bc increased bile pigment from Hb breakdown

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11
Q

What are cholesterol stones made up of?

A

Purely cholesterol

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12
Q

What are pigment stones made up of?

A

Purely bile pigment

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13
Q

What are the risk factors for gall stones? (5 things)

A
  1. Fat
  2. Female
  3. Fertile
  4. Forty
  5. FHx

5 F’s

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14
Q

What are some other risk factors for gall stones? (4 things)

A
  1. Pregnancy
  2. COCP
  3. Haemolytic anaemia
  4. Malabsorption
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15
Q

How can COCP cause gall stones?

A

Oestrogen causes more cholesterol to be secreted into bile

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16
Q

What are the clinical features of Acute Cholecystitis?

A
  1. Constant RUQ / epigastric pain
  2. Fever
  3. Murphy’s sign @ examination
  4. Guarding = GB perforation
17
Q

Where does the RUQ pain of Acute Cholecystitis refer to?

A

Right shoulder

18
Q

What is the difference in clinical features between biliary colic and Acute Cholecystitis?

A

Inflammatory component (local peritonism / fever / increased WBC)

19
Q

What happens when the gall stones move to the Common Bile Duct (CBD) ?

A
  1. Obstructive jaundice

2. Cholangitis

20
Q

What is Murphy’s Sign?

A
  1. Apply pressure with 2 fingers @ RUQ
  2. Ask patient to inspire
  3. Positive Murphy’s Sign = halt in inspiration bc pain = inflamed GB

Team GB Andy Murray aka Murphy

21
Q

What are other differentials that present with RUQ pain when suspecting Acute Cholecystitis? (4 things)

A
  1. GORD
  2. Peptic Ulcer Disease (PUD)
  3. Acute Pancreatitis
  4. IBD
22
Q

What lab tests should be done for suspected Acute Cholecystitis?

A
  1. FBC
  2. CRP
  3. LFT
  4. Amylase (or lipase)
  5. Urinalysis (+ pregnancy test if relevant)
23
Q

Why should FBC and CRP be done for suspected Acute Cholecystitis?

A

To assess for presence of inflammatory response

High WBC + CRP

24
Q

Why should LFT’s be done for suspected Acute Cholecystitis? (2 things)

A

High LFT’s (e.g Bilirubin) = Duct occlusion

25
Q

Why should Amylase (or lipase) test be done for suspected Acute Cholecystitis?

A

To check for evidence of pancreatitis

26
Q

Why should Urinalysis (+ pregnancy test if relevant) be done for suspected Acute Cholecystitis?

A

To exclude renal / tubo-ovarian pathology

27
Q

What is the first line imaging technique for Acute Cholecystitis?

A

Trans-abdominal US

28
Q

What can be visualised on an US in Acute Cholecystitis? (4 things)

A
  1. Presence of gallstones / sludge (start of gallstone formation)
  2. GB wall thickness (thick = inflamm. likely)
  3. Shrunken GB
  4. Bile duct dilatation ( = possible stone in distal bile ducts)
29
Q

What scan should be done if US for Acute Cholecystitis is inconclusive?

What does it show?

A

MRCP

Shows defects in biliary tree

30
Q

How should a patient with Acute Cholecystitis be managed? (4 things)

A
  1. IV abx (co-amoxiclav +/- metronidazole)
  2. Analgesia
  3. Anti-emetics
  4. Laparoscopic cholecystectomy within 1 week (if fit 4 surgery)
31
Q

How can a patient with Acute Cholecystitis who is not fit for surgery and not responding to abx be managed?

Wbat is the down side to this?

A

Percutaneous cholecystostomy –> drain infection

Gall stones still remain inside so still risk of recurring disease

32
Q

What are the complications of Acute Cholecystitis? (4 things)

A
  1. Gangrenous Cholecystitis (20%)
  2. Perforation (10%)
  3. Gallbladder empyema
  4. Cholecystoenteric Fistula (usually seen with Chronic cholecystitis)
33
Q

What does a Cholecystoenteric Fistula result in?

A

Air in biliary tree (pneumobilia)

34
Q

What happens if a gall stone passes through a Cholecystoenteric Fistula?

A

Results in gall stone ileus (narrowing??)

#Phase 2.1: Peri Op (24 decks)

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