CSI 12

Question 1

Where was the region of pain located? Nmae the 9 quadrants

Answer 1

Right hypochondriac region

Question 2

2 Horizontal lines in the 9 quadrants

Answer 2

transplyoric and transtubercular

Question 3

Reasons of RUQ (R hypo) pain

Answer 3

resp/cardiac causes
hepatitis
cholanigits

Question 4

Latin for gallstones?

Answer 4

Cholelithasis

Question 5

Billary colic: symptoms, investigations?

Answer 5

TEMPORARY pain in URQ. gall stones causing obstruction (either in gallbladder or cystic duct). USS abdo. not inflammed/infected.

Question 6

Cholecystitis

Answer 6

galls tones in cystic duct not affecting liver. Positiive murohys sign. happens after eating fatty foods. WBC CRP Nuet raised.

Question 7

What is a posiitve murphys sign

Answer 7

Inhale then put 2 fingers on right subcostal margain. exhale and feel pai as gall baldder goes down.

Question 8

Ascending cholangitis

Answer 8

GS in common bile duct. LFTs abnormal. ALP raised.
Charcot’s triad and reynolds pentads (sepsis).

Question 9

charcots traids and reynolds pentad

Answer 9

jaudice fever pain + low bp, confusion

Question 10

Other complications caused by gallstones

Answer 10

pancreatitis
GS ilues

Question 11

how does GS cause pancreatitis

Answer 11

GS stuck in major dudoenal pappillae -> backflow of digestive enzymes, start attacking pancreas.

Question 12

Gallstone ilues

Answer 12

Perforated GB wall and duodenal wall. GS can slip through and get stuck/ obstruction in illeocaecal valve.

Question 13

bile composition?

Answer 13

Water(97)
Bile salts (1/2)
Fats (0.)
Bilirubin (0.)

Question 14

3 ways GS can form

Answer 14

• Supersaturation
• Hypomotility
• Nucleation

Question 15

What is supersaturation and what causes it?

Answer 15

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.

Question 16

hypomotility

Answer 16

Less cntraction of GB by CCK (I cells) or Ach
Diabetic choelithasis or rapid weight loss.

Question 17

Kinetic factors? nucleuation

Answer 17

Proteins promoting crystallistaion (eg mucin)

Question 18

RFs + explaination (8)

Answer 18

-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)

Question 19

Complications: early vs late, general vs specific

Answer 19

bleeding (E,G)
infection (E,G)
hernia(L,G)
organ injury,scar tissue (E,S)
chronic pain (S,L)

Question 20

Radiography first line

Answer 20

USS Abdo
CT -> not all stones seen (cholesterol stones are radiolucent)
MRCP

Question 21

black/brown/white stones

Answer 21

Black -> haemolytic anaemia bilirubin
Brown -> bilirubin and cholesterol excess, infection
White -> cholesterol

Question 22

assess capacity (4)

Answer 22

• Able to make a decision + voice it
• Able to understand information
• To weigh information
• To retain info

Question 23

informed consent

Answer 23

tell disadvantges/advtanges - all relevant info, tailor response to personal life

Question 24

Voluntary

Answer 24

not pressured, no monetary advantage = not coerced

Question 25

What pain med is best for abdo pain?

Answer 25

Opioid

Question 26

How long does billary pain last till? when should you start to get better?

Answer 26

5+ hours

Question 27

XR is erect(standing up why?)

Answer 27

if theres a peforation, the air will rise under the diagphram when standing up so its easier to see.

Question 28

what causes hypomotility of gb

Answer 28

rapid weight loss and dm

Question 29

complications of gall stones

Answer 29

• gallbladder empyema
• Emphysematous cholecystitis
• Gallbladder perforation
• Gallbladder cancer
• Bouveret syndrome
• Pancreatitis
• Gallstone illues
• Mirizzis syndrome