GALL Flashcards
ALP INCREASE
INCREASED LIVER ENZYMES
LIVER OBSTRUCTION
PROXIMAL CBD OBSTRUCTION or hepatic duct
PANCREATIC ENZYMES INCREASE
PANCREATIC OBSTRUCTION WITH liver obstruction
DISTAL cbd DUCT BLOCK
AMPULLA OF VATER( pancreatic duct joins CBD)
raised liver and pancreatic enzymes with fever
cholangitis
rx = abx plus ERCP
pancreatic duct obsruction
LABS
both liver and
pancreas elevated enzymes
Black pigment GALL stones
cause
haeomolysis=
sickle cell
spherocytosis
thalssemia
brown pigment galls tones
cause
infection and
stasis
e coli , kleb
cholesterol gall stones
cause
hyper triglyceridemia
Gall stones risk factors
females
high animal fat diet
rapid wt loss
contraceptives
multiparity
DM
CHRONS DISEASE (lithogenic bile)
pain in gall stones obstruction
RT upper quadrant
also
epigastric pain radiating to back
cholangitis
causes
GALL stones
ercp
primary biliary tract sx
cholangitis symptoms
fever
rigors
abd pain AND tenderness
rt up quad pain
JAUNDICE
cholangitis
LABS
RAISED WBC (NEUTROPHILIA)
abnormal lft
raised ALP
slightly raised transaminases
cholangitis compli
bacteraemia
sepsis
abcess liver
pancreatitis
cholangitis rx
abx ( gram negative cover)
ercp
cholangitis dx
usg
ct
MRCP
ASYMPTOMATIC CHOLITIASIS RX
NO RX
CHOLESTEROL gall stones
factors
supersaturation of bile(high cholestrol , low salts)
inreased cholesterol nucleation
decreased galla baladder contractability
factors for gall stones formation
old age ,,
high oestrogen= females & cocp
colestyramine , clofibrate
chirrosis( bile pigment stones)…….. , chrons
ILEAL RESECTION( redusing enterohepatic circulation and increasing bilesalt loss)
AMPULLA OF VATER
obstruction
both raised pancreatic and liver enzymes
sight of joining pancreatic duct with CBD
POST-CHOLECYSTECTOMY syndrome?
bile acid diarrhoea
can be life long or transient
rx: cholestyramine , codiene
patho: due to loss of bile reservoir gall bladder thus direct flow of bile….
PSEUDO membranous colitis
clostridium difficle
also cause bloody diarrhoea
radio: dilated large bowel & mucosal oedema
