Gall Bladder Flashcards
Structures posterior to gall bladder
Transverse colon and proximal duodenum
Arterial supply of the gall bladder
Cystic artery (right hepatic-common hepatic)
Venous drainage
Cystic veins into the portal vein
Gall bladder nerve innervation
Sympathetic: Coeliac plexus
Parasympathetic: Vagus nerve
Cholelithiasis
Uncomplicated gall stones
Types of gall stones and RF
Cholesterol gall stones: most common (90%). RF: FHx, diet (obesity, metabolic syndrome, sudden weight reduction), age, and female sex hormones.
Brown pigmented gall stones: Result of stasis and infection. Unconjugated Bilirubin and calcium salts RF:Bile ducts strictures or parasitic infestation
Black pigmented: Polymerised calcium bilirubinate (5-10%). RF: age, chronic haemolytic anaemia, cirrhosis, cystic fibrosis, and ileal disease
Typical presentation of gall stones
Most asymptomatic.
Can present with RUQ pain, sometimes after food
Constant pain, increasing intensity. Pain duration <30 mins is not biliary colic. More than 5 hrs suggests complicationor cholecystitis
Key investigation for gall stones
US initial test
If unremarkable and symptoms persists CT scan or MRCP if query choledocholithiasis (common bile duct stones)
Management for gall stones
Asymptomatic: Observe
Symptomatic: Lap. Cholecystectomy
choledocholithiasis with/without symptoms: ERCP
Acute Cholecystitis
Acute gall bladder inflammation
Lasts 3-6 hours. Fever is common
RUQ tenderness with + murphy’s sign
Investigation for acute cholecystitis
US is the definitive test
If unclear then use hepatobiliary iminodiacetic acid HIDA
CT is not as good as US for diagnosing, but it is useful when obesity or gaseous distension limits ultrasound interpretation
Management of acute cholecystitis
Supportive care (fluids, analgaesia, obs)
Oral/IV Abx-cefuroxime or ciprofloxacin and metranidazole
Lap. Cholecystectomy
If poor surgical candidate:
Percutaneous cholecystectomy drainage tube
