Disease of the Gallbladder Flashcards
what is cholesterosis
an uncommon chronic inflammation of the gall bladder in which small crystals of cholesterol deposit on its internal wall (like a strawberry)
constituents of gall stones
calcium combined with
cholesterol 80-95%
OR
bilirubin 5-20%
bilirubin in gallstones is un/conjugated
unconjugated - come from the 15 of bile bilirubin which in unconjugated
which is more common, cholesterol stones or bilirubin stones
cholesterol stones
risk factors of gallstones
FH, increasing age, loss of bile salts, oral contraceptive
why would an ileal resection cause gallstones
ileum removed –> reduced reabsorption of bile salts –> fewer bile salts to emulsify cholesterol –> free cholesterol forms stones
presentation of gallstones
usually asymptomatic - lots found on autopsy
symptomatic presentation of gallstones
biliary colic (right epigastric pain)
jaundice
fat malabsorption
what is charcot’s triad
jaundice, fever and right epigastric pain - results from ascending cholangitis
what condition of galls stones in common bile duct
choledocho-lithiasis
complications of gallstones
ascending cholangitis
choledocho-lithiasis
acute pancreatitis
obstructive jaundice
symptoms of obstructive jaundice
pain, jaundice, dark urine, pale stool, pruritis
effect of excess circulating bilirubin on skin
pruritis
bloods in gallstones
LFTs (AST, ALT, ALP)
Amylase and lipase for pancreas
WCC for infection
imaging in gallstones
ultrasound endoscopic ultrasound CT scan IV cholangiography MRCP ERCP PTC
medical treatment of gallstones
dissolution by acids
lithotripsy (ultrasound shock waves to break them up)
what 2 organs are you worried about in gallstones in the common duct (choledocho-lithiasis)
liver and pancreas
surgical treatment of gallstones
laparoscopic cholecystectomy
surgical treatment for common bile duct stones
laparoscopic exloration
ERCP removal
transhepatic stone retrieval
congenital biliary tract disease
biliary atresia and choledochal cysts
what is biliary atresia
obstructed bile flow due to destruction or absence of extra-hepatic ducts
when does biliary atresia present
in babies after a few weeks with jaundice
characteristics of biliary colic
right upper quadrant, often after a meal, lasting several hours with constant severity
what are choledochal cysts
dilatations of extrahepatic ducts
what is cholangiocarcinoma
a tumour of the bile duct, usually adenocarcinoma
where in the bile duct do cholangiocarcinomas tend to occur
mostly at the hepatic bifurcation but can also be intrahepatic or closer towards ampulla
nature of cholangiocarcinoma presentation
obstructive jaundice symptoms
esp itching
treament of cholangiocarcinoma
surgical removal
otherwise palliative
prognosis of cholangiocarcinoma
very poor
