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Alimentary Clinical medicine > Diseases of the Gallbladder and Biliary Tract > Flashcards

Diseases of the Gallbladder and Biliary Tract Flashcards

1
Q

what is the composition of gallstones?

A

cholesterol

pigment

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2
Q

what are the risk factors for cholesterol gallstones?

A 
age
gender
multiparity
oral contraceptive
obesity
high fat and low fibre diets
cystic fibrosis
ileal disease
cirrhosis
diabetes
delayed gallbladder emptying
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3
Q

what are the risk factors for pigment gallstones?

A

hyperbilirubinbilia
gilbert syndrome
bile infection
haemolytic anaemia

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4
Q

what is the presentation of gallstones?

A

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

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5
Q

what investigations are used to diagnose gallstones?

A

labs: LFT’s, AST, ALT, ALP
USS/ endoscopic USS
MRCP
IV cholangiography

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6
Q

what treatment is given topple with gallstones?

A

asymptomatic then no treatment

non-operative = lithotripsy or dissolution
surgery = cholecystectomy
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7
Q

what gender is gallstones more common in?

A

female

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8
Q

what is acute cholecystitis?

A

the obstruction of gallbladder emptying

in 95% of cases it is due to a gallstone

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9
Q

what is choledocho-lithiasis?

A

also known as common gallstones in the common bile duct CBD

it is when gallstones are found in the common bile duct

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10
Q

what is the presentation of choledocho lithiasis?

A

jaundice
fever due to acute/ascending cholangitis
biliary colic (abdominal pain)
acute pancreatitis

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11
Q

what can cause a benign biliary stricture?

A

iatrogenic
gallstone related
inflammation i.e. protozoal, pyogenic, primary clerking cholangitis, pancreatitis, HIV

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12
Q

what are the congenital causes of benign biliary tract disease?

A

biliary atresia

choledochal cysts

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13
Q

what are the 2 obstructive jaundice causing malignant tumours?

A

cholangiocarcinoma

cancer of the head of the pancreas

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14
Q

what are the different types of cholangiocarcinoma?

A

intra hepatic
extrahepatic
ampullary cancer
gallbladder cancer

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15
Q

what are the risk factors for cholangiocarcinoma?

A

primary sclerosis cholangitis
Inflammatory bowel disease
choledochal malformations
carcinogens i.e. aflatoxins

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16
Q

what is the presentation of cholangiocarcinoma?

A

painless jaundice
itching
non specific symptoms i.e. weight loss, pale stool, dark urine

17
Q

what investigations can be carried out to diagnose cholangiocarcinoma?

A 
labs
USS/endoscopic USS
CT 
MRA
MRCP
angiography
FDG PET
cholangioscopy
Cytology
18
Q

what is the treatment for cholangiocarcinoma?

A

surgical only curative option

palliative - bypass, stenting, radio and chemo, PDT, liver transplant

19
Q

what are the 3 types of intra hepatic cholangiocarcinomas?

A

mass forming
intra ductal
periductal

20
Q

patients with what condition are at risk of developing peri-ampullary tumours?

A

familial adenomatous polyps

21
Q

what is acute cholecystitis?

A

gallstone in the cystic duct which causes inflammation

22
Q

what blood tests are carried out when investigating gallstones?

A

LFT’s, ALT, AST, AlkP,
Amylase, Lipase
White cell count

23
Q

where would you experience pain due to gallstones and why?

A

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

24
Q

what are the complications of choledoco-litiasis?

A

obstructive jaundice
acute pancreatitis
acute/ascending cholangitis

25
Q

what is acute cholangitis?

A

inflammation of the bile duct

26
Q

what symptoms/signs does obstructive jaundice cause?

A 
pain
pale stool
dark urine
steatorrhea
pruritus
27
Q

what is the treatment for ampullary cancer?

A

pancreatico-duodectomy

28
Q

what carcinogen can put people at risk of developing cholangiocarcinoma?

A

Aflatoxins

produced from fungi

Alimentary Clinical medicine (23 decks)

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