Diseases of the Biliary Tree Flashcards
what is another name for gallstones?
Cholelithiasis
what are gallstone?
hard stone-like material formed within biliary system
do gallstones tend to present acutely?
no-only 7% present acutely
are gallstones more common in women or men?
women >40yo
aetiology of gallstones?
hyperlipidaemia, diabetes, gall bladder dysmotility, prolonged fasting, crohn’s
what are 5fs to remember for gallstones?
Fat Fair skinned Fertile Forty Female
classes of gallstones?
1y Biliary Colic, Cholecystitis
what is 1y Biliary Colic?
thickened wall of bladder due to fibrosis as stone impacts in cystic duct
where is pain felt in 1y Biliary Colic?
RUQ- gradual and radiates to back and shoulder
what is cholecystitis?
inflammation of GB
how can cholecystitis present?
acutely: stone blocks outflow of bile
chronic: insidious presentation or after bouts of acute cholecystitis
complications of cholecystitis?
adhesions, empyema, peritonitis
tx for cholecystitis?
IV antibiotics, urgent cholecystectomy
pathology of gallstones?
abnormal composition of bile e.g. excess cholesterol, bile stasis or infection which may cause an imbalance of cholesterol to bile salts disrupting micelle formation
4 types of stone?
mixed
pure cholesterol
pigmented (excess bilirubin due to high haemolysis)
1y bile duct stones
s/s of gallstones?
asymptomatic but 1y biliary colic presents differently
Dx of gallstones?
USS, MRCP/ERCP, CT, HIDA, endoscopic US
tx for 1y biliary colic?
low fat diet/ wt loss, ursodeoxycholic acid. if recurrent do a cholecystectomy
how does ursodeoxycholic acid work?
reduces absorption of cholesterol
tx for acute cholecystitis?
IV antibiotics, urgent laparoscopic cholecystectomy
complications of gallstones?
stone ma migrate to common bile duct causing jaundice, cholangitis, acute pancreatitis, gallstone ileum
symptoms for CBD impaction?
itch, nausea, jaundice
ix for CBD impaction by gallstone?
MRCP & LFTs
tx for CBD impaction?
ERCP/ surgery
what is a gallstone ileus?
large gallstone that passes into SI
an intermittent colic is when…
large gallstone moves down SI
s/s of gallstone ileus?
campy abdominal pain, nausea, vomiting
tx for gallstone ileus?
laparotomy of small intestine enterotomy to remove stone
then cholecystectomy after 3 months
epidemiology of cholangiocarcinoma?
relatively rare
what type of cancer is cholangiocarcinoma?
adenocarcinoma
risk factors & aetiology for cholangiocarcinoma?
Ulcerative Colitis, PSC
presentation of cholangiocarcinoma?
tends to be caught late- jaundice*, wt loss, lethargy
staging for cholangiocarcinoma?
duplex USS, CT/ERCP, MRI/ MRCP
tx for cholangiocarcinoma?
surgical resection, biliary stent is palliative
what is the difference between MRCP and ERCP
both are used to investigate biliary obstruction or pancreatic disease (mainly ducts)..
MRCP is imaging (like MRI so non-invasive)
ERCP is endoscopic so invasive