Cholelithaisis / Choledocholithiasis Management Flashcards
What is the typical presentation of biliary colic?
Sudden onset of dull, colicky RUQ pain lasting <4 hours
May radiate to epigastrum/back
Often precipitated by fatty foods
Cholelithaisis vs. Choledocholithiasis
Cholelithiasis refers to the presence of gallstones within the gallbladder, while choledocholithiasis specifically refers to the presence of gallstones within the common bile duct (CBD)
What are the characteristics of acute cholecystitis?
Constant RUQ pain lasting >4 hours
What is the triad associated with ascending cholangitis?
Charcot’s triad:
* RUQ pain
* Fever
* Jaundice
What does Reynolds’ pentad indicate?
Charcot’s triad (RUQ pain, fever, and jaundice) + hypotension + confusion, indicates septic cholangitis
What are the risk factors for gallstone disease?
5 F’s: fat, female, fertile, forty, family history
What is Kehr’s sign associated with?
Right shoulder tip pain in biliary colic
What is Murphy’s sign indicative of?
Arrest of inspiration while palpating the right subcostal area in acute cholecystitis
What is Boas sign?
Hyperaesthesia to light touch in the right lower scapular region or RUQ of the abdomen, seen in acute cholecystitis
What are the common symptoms of biliary obstruction?
Jaundice and icterus
What blood tests are typically done for gallstone disease?
FBC, U&E, CRP, LFTs
What imaging is considered the gold standard for gallstones?
MRCP (Magnetic Resonance Cholangiopancreatography) is a non-invasive imaging test that uses MRI to examine the bile ducts, pancreas, and pancreatic duct. It’s similar to a more invasive procedure called ERCP (Endoscopic Retrograde Cholangiopancreatography) but avoids the need for an endoscope. MRCP can help diagnose issues like gallstones, tumors, infections, or inflammation in these organs.
What is the initial treatment for biliary colic?
Analgesia (paracetamol +/- NSAIDs +/- opiates)
What lifestyle advice is recommended for managing biliary colic?
Low fat diet, weight loss, increased exercise
What is the timeframe for elective cholecystectomy after presentation for biliary colic?
Within 6 weeks of presentation
What initial treatments are recommended for acute cholecystitis?
NPO, fluid resuscitation, analgesia + antiemetics, IV antibiotics (e.g. co-amoxiclav + metronidazole)
What is the recommended timeframe for laparoscopic cholecystectomy in acute cholecystitis?
Within 1 week of presentation, ideally within 72 hours
What are the initial management for ascending cholangitis?
Fluid resuscitation
Routine bloods
Blood cultures
Broad-spectrum IV antibiotics (e.g. co-amoxiclav and metronidazole)
What procedures may be performed for ascending cholangitis?
ERCP +/- sphincterotomy and stenting, PTC (if unfit for ERCP)
True or False: Most individuals with gallstones are symptomatic.
False
What does bile duct dilation indicate?
Ascending cholangitis
What is the treatment for Acute Colycystics/ Ascnecding Cholangitis for those unfit for ERCP?
Percutaneous cholecystostomy (PTC)
