Diseases of the gall bladder Flashcards
Cause of abnormal ALT
Liver cell damage
Cause of abnormal AST
Liver cell damage
Cause of abnormal Alk P
Biliary blockage
Cause of abnormal gamma-GT
Biliary blockage
Cause of abnormal albumin
Impaired synthesis
What happens to bilirubin in liver?
Liver adds glucuronide
What is conjugation?
Albumin attached to unconjugated bilirubin
What is Gilbert syndrome?
Lack of conjugation enzyme
Gall bladder function
- Reservoir for bile
- 1l produced per day by liver
- Acts under hormonal signal (CCK) and neural stimulation from vagus
- Bile secreted into duodenum lumen and emulsifies fat
Cholelithiasis
Stone formation within gall bladder - cholesterol in developed world and pigment stones in developing
Biliary colic
Stones cause pain and inflammation - gall bladder contracts to force a stone to occlude its outlet, high pressure means gallbladder distends due to pain
Colic pain
Caused by peristalsis - comes in waves
US for gall stones
- Gold standard
- Reflective echogenic focus within gallbladder lumen, normally with prominent posterior acoustic shadowing regardless of pathological type
- Gravity-dependent movement is often seen with change of pt position (rolling stone signs)
- Twinkling artefact is seen with colour flow Doppler ultrasound - occurs as a focus of alternating colours on Doppler signal behind reflective object (gall stone). Appears with or without associated colour comet-tail artefact
MRCP
- Magnetic resonance cholangiopancreatography
- Can also be used as treatment - traps and captures stones to pull them out
- Air pushed in to inflate abdomen - gallbladder removed via a port
Acute cholecystitis
Inflammation of gall bladder
RUQ pain/mass/Murphy sign - evidence of inflammation
USS RUQ
Analgesia required
Ascending Cholangitis
Infection of biliary tree - obstructed
Charcot’s triad (RuQ pain, fever and jaundice) and Reynold’s pentad (RUQ pain, fever, jaundice, low BP, confusion)
Leads to accumulation of bilirubin
USS and MRCP needed
Biliary colic
Stone causing intermittent obstruction of GB outlet
Intermittent RUQ pain, nausea
USS shows stone, bloods normal
Treated by cholecystectomy
Cholecystitis
Inflammation of GB second to stones
Permanent RUQ pain, Murphy sign positive, inflammation
USS shows stones, WBC and CRP elevated
Cholecystectomy
Ascending Cholangitis
Obstructed CBD - reflux into hepatobiliary system
RUQ pain, fever and jaundice, confusion and hypotension
CBD dilated, CRP and FLT abnormal
ERCP
