Diseases of the Gallbladder and Biliary Tract Flashcards
what is the composition of gallstones?
cholesterol
pigment
what are the risk factors for cholesterol gallstones?
age gender multiparity oral contraceptive obesity high fat and low fibre diets cystic fibrosis ileal disease cirrhosis diabetes delayed gallbladder emptying
what are the risk factors for pigment gallstones?
hyperbilirubinbilia
gilbert syndrome
bile infection
haemolytic anaemia
what is the presentation of gallstones?
most people are asymptomatic
gallbladder in cystic or common bile duct = biliary colic
gallstone causing pancreatitis
gallstone in cystic duct causing acute cholecystitis
empyema
perforation causing peritonitis
obstruction causing jaundice
what investigations are used to diagnose gallstones?
labs: LFT’s, AST, ALT, ALP
USS/ endoscopic USS
MRCP
IV cholangiography
what treatment is given topple with gallstones?
asymptomatic then no treatment
non-operative = lithotripsy or dissolution surgery = cholecystectomy
what gender is gallstones more common in?
female
what is acute cholecystitis?
the obstruction of gallbladder emptying
in 95% of cases it is due to a gallstone
what is choledocho-lithiasis?
also known as common gallstones in the common bile duct CBD
it is when gallstones are found in the common bile duct
what is the presentation of choledocho lithiasis?
jaundice
fever due to acute/ascending cholangitis
biliary colic (abdominal pain)
acute pancreatitis
what can cause a benign biliary stricture?
iatrogenic
gallstone related
inflammation i.e. protozoal, pyogenic, primary clerking cholangitis, pancreatitis, HIV
what are the congenital causes of benign biliary tract disease?
biliary atresia
choledochal cysts
what are the 2 obstructive jaundice causing malignant tumours?
cholangiocarcinoma
cancer of the head of the pancreas
what are the different types of cholangiocarcinoma?
intra hepatic
extrahepatic
ampullary cancer
gallbladder cancer
what are the risk factors for cholangiocarcinoma?
primary sclerosis cholangitis
Inflammatory bowel disease
choledochal malformations
carcinogens i.e. aflatoxins
what is the presentation of cholangiocarcinoma?
painless jaundice
itching
non specific symptoms i.e. weight loss, pale stool, dark urine
what investigations can be carried out to diagnose cholangiocarcinoma?
labs USS/endoscopic USS CT MRA MRCP angiography FDG PET cholangioscopy Cytology
what is the treatment for cholangiocarcinoma?
surgical only curative option
palliative - bypass, stenting, radio and chemo, PDT, liver transplant
what are the 3 types of intra hepatic cholangiocarcinomas?
mass forming
intra ductal
periductal
patients with what condition are at risk of developing peri-ampullary tumours?
familial adenomatous polyps
what is acute cholecystitis?
gallstone in the cystic duct which causes inflammation
what blood tests are carried out when investigating gallstones?
LFT’s, ALT, AST, AlkP,
Amylase, Lipase
White cell count
where would you experience pain due to gallstones and why?
epigastric pain
the gallbladder is a foregut structure therefore the nerves originate from the midline which is why the pain is felt in the midline and not the right hypochondrium
what are the complications of choledoco-litiasis?
obstructive jaundice
acute pancreatitis
acute/ascending cholangitis
what is acute cholangitis?
inflammation of the bile duct
what symptoms/signs does obstructive jaundice cause?
pain pale stool dark urine steatorrhea pruritus
what is the treatment for ampullary cancer?
pancreatico-duodectomy
what carcinogen can put people at risk of developing cholangiocarcinoma?
Aflatoxins
produced from fungi
