Diseases of the Biliary Tree

Question 1

what is another name for gallstones?

Answer 1

Cholelithiasis

Question 2

what are gallstone?

Answer 2

hard stone-like material formed within biliary system

Question 3

do gallstones tend to present acutely?

Answer 3

no-only 7% present acutely

Question 4

are gallstones more common in women or men?

Answer 4

women >40yo

Question 5

aetiology of gallstones?

Answer 5

hyperlipidaemia, diabetes, gall bladder dysmotility, prolonged fasting, crohn’s

Question 6

what are 5fs to remember for gallstones?

Answer 6

Fat
Fair skinned
Fertile 
Forty 
Female

Question 7

classes of gallstones?

Answer 7

1y Biliary Colic, Cholecystitis

Question 8

what is 1y Biliary Colic?

Answer 8

thickened wall of bladder due to fibrosis as stone impacts in cystic duct

Question 9

where is pain felt in 1y Biliary Colic?

Answer 9

RUQ- gradual and radiates to back and shoulder

Question 10

what is cholecystitis?

Answer 10

inflammation of GB

Question 11

how can cholecystitis present?

Answer 11

acutely: stone blocks outflow of bile
chronic: insidious presentation or after bouts of acute cholecystitis

Question 12

complications of cholecystitis?

Answer 12

adhesions, empyema, peritonitis

Question 13

tx for cholecystitis?

Answer 13

IV antibiotics, urgent cholecystectomy

Question 14

pathology of gallstones?

Answer 14

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

Question 15

4 types of stone?

Answer 15

mixed
pure cholesterol
pigmented (excess bilirubin due to high haemolysis)
1y bile duct stones

Question 16

s/s of gallstones?

Answer 16

asymptomatic but 1y biliary colic presents differently

Question 17

Dx of gallstones?

Answer 17

USS, MRCP/ERCP, CT, HIDA, endoscopic US

Question 18

tx for 1y biliary colic?

Answer 18

low fat diet/ wt loss, ursodeoxycholic acid. if recurrent do a cholecystectomy

Question 19

how does ursodeoxycholic acid work?

Answer 19

reduces absorption of cholesterol

Question 20

tx for acute cholecystitis?

Answer 20

IV antibiotics, urgent laparoscopic cholecystectomy

Question 21

complications of gallstones?

Answer 21

stone ma migrate to common bile duct causing jaundice, cholangitis, acute pancreatitis, gallstone ileum

Question 22

symptoms for CBD impaction?

Answer 22

itch, nausea, jaundice

Question 23

ix for CBD impaction by gallstone?

Answer 23

MRCP & LFTs

Question 24

tx for CBD impaction?

Answer 24

ERCP/ surgery

Question 25

what is a gallstone ileus?

Answer 25

large gallstone that passes into SI

Question 26

an intermittent colic is when…

Answer 26

large gallstone moves down SI

Question 27

s/s of gallstone ileus?

Answer 27

campy abdominal pain, nausea, vomiting

Question 28

tx for gallstone ileus?

Answer 28

laparotomy of small intestine enterotomy to remove stone

then cholecystectomy after 3 months

Question 29

epidemiology of cholangiocarcinoma?

Answer 29

relatively rare

Question 30

what type of cancer is cholangiocarcinoma?

Answer 30

adenocarcinoma

Question 31

risk factors & aetiology for cholangiocarcinoma?

Answer 31

Ulcerative Colitis, PSC

Question 32

presentation of cholangiocarcinoma?

Answer 32

tends to be caught late- jaundice*, wt loss, lethargy

Question 33

staging for cholangiocarcinoma?

Answer 33

duplex USS, CT/ERCP, MRI/ MRCP

Question 34

tx for cholangiocarcinoma?

Answer 34

surgical resection, biliary stent is palliative

Question 35

what is the difference between MRCP and ERCP

Answer 35

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