CSI 12 Flashcards
Where was the region of pain located? Nmae the 9 quadrants
Right hypochondriac region
2 Horizontal lines in the 9 quadrants
transplyoric and transtubercular
Reasons of RUQ (R hypo) pain
resp/cardiac causes
hepatitis
cholanigits
Latin for gallstones?
Cholelithasis
Billary colic: symptoms, investigations?
TEMPORARY pain in URQ. gall stones causing obstruction (either in gallbladder or cystic duct). USS abdo. not inflammed/infected.
Cholecystitis
galls tones in cystic duct not affecting liver. Positiive murohys sign. happens after eating fatty foods. WBC CRP Nuet raised.
What is a posiitve murphys sign
Inhale then put 2 fingers on right subcostal margain. exhale and feel pai as gall baldder goes down.
Ascending cholangitis
GS in common bile duct. LFTs abnormal. ALP raised.
Charcot’s triad and reynolds pentads (sepsis).
charcots traids and reynolds pentad
jaudice fever pain + low bp, confusion
Other complications caused by gallstones
pancreatitis
GS ilues
how does GS cause pancreatitis
GS stuck in major dudoenal pappillae -> backflow of digestive enzymes, start attacking pancreas.
Gallstone ilues
Perforated GB wall and duodenal wall. GS can slip through and get stuck/ obstruction in illeocaecal valve.
bile composition?
Water(97)
Bile salts (1/2)
Fats (0.)
Bilirubin (0.)
3 ways GS can form
- Supersaturation
- Hypomotility
- Nucleation
What is supersaturation and what causes it?
Bilirubin/cholesterol comes out of solution into GB and forms stones
Bilirubin /cholesterol increase: diet, haemolytic anaemia, oestrogen (female), lack of enzymes (older people)
water, bile salts decrease: IBS (the enteric bile salt system), dehydration.
hypomotility
Less cntraction of GB by CCK (I cells) or Ach
Diabetic choelithasis or rapid weight loss.
Kinetic factors? nucleuation
Proteins promoting crystallistaion (eg mucin)
RFs + explaination (8)
-Obesity (high cholesterol)
-Hyperlipidaemia (“”)
-Female, OCP, fertile (oestrogen can increase serum cholesterol)
-Rapid weght loss (less GB contraction)
-Diabetes (“””)
-40+(lack of enzymes breaking down bilirubin)
-Haemolytic anaemia (bilirubin)
-crohns (recycling of bile salts, coming out of solution)
Complications: early vs late, general vs specific
bleeding (E,G)
infection (E,G)
hernia(L,G)
organ injury,scar tissue (E,S)
chronic pain (S,L)
Radiography first line
USS Abdo
CT -> not all stones seen (cholesterol stones are radiolucent)
MRCP
black/brown/white stones
Black -> haemolytic anaemia bilirubin
Brown -> bilirubin and cholesterol excess, infection
White -> cholesterol
assess capacity (4)
- Able to make a decision + voice it
- Able to understand information
- To weigh information
- To retain info
informed consent
tell disadvantges/advtanges - all relevant info, tailor response to personal life
Voluntary
not pressured, no monetary advantage = not coerced
What pain med is best for abdo pain?
Opioid
How long does billary pain last till? when should you start to get better?
5+ hours
XR is erect(standing up why?)
if theres a peforation, the air will rise under the diagphram when standing up so its easier to see.
what causes hypomotility of gb
rapid weight loss and dm
complications of gall stones
- gallbladder empyema
- Emphysematous cholecystitis
- Gallbladder perforation
- Gallbladder cancer
- Bouveret syndrome
- Pancreatitis
- Gallstone illues
- Mirizzis syndrome
