Cholelithiasis

Question 1

risk factors for gall stones

Answer 1

4 Fs
fat
female
fair - caucasian
fourty - middle aged

Question 2

what causes the colicky pain felt in cholelithiasis

Answer 2

fat in the duodedum stimulates CCK release from I cells.
this causes contraction of the gall bladder
stones are compressed against the gall bladder wall leading to pain
the pain can last 30 mins up to 8 hours

Question 3

what are some causes of obstructive jaundice

Answer 3

choledocholithiasis (stone in bile duct)
tumour of the head of pancrease
cholangiocarcinoma

Question 4

where is ALP found

Answer 4

liver and billary system
also bones
can be raised in pregnancy as its released from the placenta too

Question 5

what is first line investigation for gall stone disease

Answer 5

RUQ USS
more specific than USS

Question 6

what can be seen in USS of gall stone disease

Answer 6

visualise the stone
dilation of the common bile duct (>6cm)
thickening of the gall bladder wall (cholecystitis)

Question 7

what factors can affect the ability to perform USS for suspected gall stones

Answer 7

weight
gas in the abdomen
discomfort
user dependent

Question 8

what is MRCP

Answer 8

magnetic resonance cholangio-pancreatography
MRI for the billary system
used if no signs detected on USS but clinical presentation of gall stones
more specific and sensitive

Question 9

what is ERCP

Answer 9

endoscopic retrograde cholangiopancreatography
can be used for stents, sphincterotomy, biopsy and clearing stones
uses contrast and XR

Question 10

what are complications of ERCP

Answer 10

excessive bleeding
cholangitis
pancreatitis

Question 11

what are some complication of cholecystectomy

Answer 11

general: bleeding, scars, infection, VTE

can get damage to the billary system, surrouding organs and vessels, stones may be left
post cholecystectomy syndrome

Question 12

what is post cholecystectomy syndrome

Answer 12

RUQ pain
N&V
indigestion
intolerance to fatty foods
diarrhoea

Question 13

describe cholelithiasis

Answer 13

gall stones in the gall bladder
colicky RUQ pain, +/- N&V
managed with elective cholecystectomy if symptomatic

Question 14

describe cholecystitis

Answer 14

cystic duct obstruction with inflammation
constant pain and fever
positive murphys sign
requires more urgent cholecystectomy as there is risk of ischaemia/ necrosis

Question 15

describe choledocholithiasis

Answer 15

stone obstructing the common bile duct
with inflammation proximal to obstruction
RUQ pain and jaundice
ERCP to remove stone
later elective cholecystectomy

Question 16

describe the presentation of ascending cholangitis

Answer 16

charcots triad: RUQ pain, fever jaundice
reynolds pentad: all of the above plus hypotension and confusion

Question 17

what is ascending cholangitis

Answer 17

stone obstructing the common bile duct with infection

Question 18

what are the most commonly associated infective organisms of cholangitis

Answer 18

E.coli
Klebsiella species
enterococcus

Question 19

what is the management of cholangitis

Answer 19

may have sepsis - manage this
start broad spec ABX
emergency ERCP