Cholecystitis and Cholangitis

Question 1

What does the liver produce when you eat fats? And what does that do?

Answer 1

• Bile
• Emulsifies fats

Question 2

What is emulsification?

Answer 2

When the fat is split into smaller pieces so that the surface area for metabolism is much larger

Question 3

What are hepatocytes and what do they produce?

Answer 3

Liver cells and they produce bile

Question 4

How do hepatocytes produce bile?

Answer 4

Secreting bilirubin, bile salts, cholesterol, phospholipids, proteins, ions, and water into their canaliculi

Question 5

What does bile store and concentrate some bile?

Answer 5

In the gall bladder so that it has a much larger storage of bile to use when needed.

Question 6

When you eat something with fat in, where else produces bile?

Answer 6

• Liver
• Gall bladder will contract and squeeze out its bile

Question 7

What is Cholangitis?

Answer 7

Inflammation of the bile duct system

• Common hepatic duct
• Cystic duct
• Common bile duct
• Gallbladder

Question 8

What is Cholecystitis?

Answer 8

Inflammation of the Gallbladder and majority of the time is due to a gall stone blockage

Question 9

What is functional cystic duct obstruction?

Answer 9

Often present and is associated with bile stasis or thickening

Question 10

What is Charcot’s Triad and Reynold’s Pentad?

Answer 10

Charcot’s Triad
- Seen around 50 - 70% cases
- Fever
- Jaundice - best seen in the sclera
- RUQ pain

Shock and confusion in serious cases with systemic sepsis

Reynold’s Pentad
- Fever
- Jaundice
- RUQ pain
- Shock
- Confusion

Question 11

Symptoms of Cholangitis?

Answer 11

• RUQ / epigastric pain
• Fevers
• Malaise
• Nausea/Vomiting

Question 12

What are the signs Cholangitis?

Answer 12

• RUQ / epigastric tenderness
• Pyrexia = fever
• Jaundice
• Hypotension (severe cases)
• Confusion (severe cases)

Question 13

What is Choledocholithiasis?

Answer 13

• Stones in the bile duct
• Most common cause of acute cholangitis

Question 14

What is Acute Cholangitis?

Answer 14

Impaired drainage and bacterial overgrowth
Most common cause of ascending cholangitis, 80% of causes

Question 15

Referred pain - what happens when the gallbladder is inflamed and swollen?

Answer 15

• Irritates your phrenic nerve which stretches the abdomen through the chest and into your neck
• Each time you ear a fatty meal, it aggravates the nerve and causes referred pain in the right shoulder blade

Question 16

What assessment is used for Cholangitis and what is it?

Answer 16

• Murphy’s Sign
• As the patients takes a deep breath in , gently palpate in the lowermost right anterior rib cage of the abdomen at the midclavicular line
• If the acutely inflamed gallbladder contract the examining fingers, pain will be evoked with the arrest of inspiration

Question 17

What is the treatment for Cholangitis?

Answer 17

• Recognise the signs and symptoms
• Pain relief and symptom management
• Hospital is essential
• Treatment is always surgical
• Patients places on a waiting list for surgery in uncomplicated cases
• Life threatening performed as soon as possible
• Necrotising gallbladders can become sticky and adhere themselves to the liver