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GI and General Surgery > Gall Bladder > Flashcards

Gall Bladder Flashcards

1
Q

What are risk factors for developing gallstones?

A 
high fat diet, obesity 
pregnant 
female 
family history 
age >40
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2
Q

Why do gallstones form?

A

abnormal bile composition

bile stasis

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3
Q

What are the main components of gall stones?

A

cholesterol
pigment - bilirubin

an excess of either leads to gall stones

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4
Q

What is biliary colic?

A

gallbladder neck/cystic duct impacted by a gallstone
contraction of gall bladder around stone causes pain
no inflammatory response

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5
Q

What are the clinical features of biliary colic?

A

RUQ pain (colicky), radiates to shoulder/back
nausea, indigestion
pain precipitated by eating (esp. fatty foods)

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6
Q

Why does eating fatty foods precipitate biliary colic?

A

fatty acids - duodenum releases CKK

gall bladder contracts (round the stone)

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7
Q

What is acute cholescystitis?

A

inflammation in gall bladder - obstruction of cystic duct

initially sterile- becomes infected

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8
Q

What are the clniical features of acute cholecystitis?

A

RUQ pain
signs of inflammation - fever, lethargy

O/E: tender RUQ, Murphy’s sign positive

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9
Q

What is Murphy’s sign?

A

apply pressure on RUQ and get patient to inspire - positive if halt in inspiration due to pain

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10
Q

What are investigations for biliary colic and cholecystitis?

A

blood tests:

  • FBC and CRP (raised in cholecystitis)
  • LFTs - raised ALP (ductal occlusion)
  • amylase - pancreatitis?

imaging:

  • USS: presence of stones, gallbladder wall thickness from inflammation, bile duct dilatation - stone in distal bile ducts
  • MRCP - magnetic resonce cholangiopancreatography
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11
Q

What is the management of biliary colic?

A

analgesia
lifestyle factors: weight loss, low fat diet, exercise
ERCP
elective lap chole. (development of complications)

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12
Q

What are complications of ERCP?

A

perforation
bleeding
pancreatitis

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13
Q

What treatments can be done via ERCP?

A

stone removal
stenting
sphincterotomy

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14
Q

What is the management of acute cholecystitis?

A

IV antibiotics, analgesia, antiemetic
NBM
lap chole

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15
Q

What are the complications of lap chole?

A

infection, bleeding
injury to CBD
conversion to open operation

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16
Q

What are the complications of gallstones?

A 
acute pancreatitis - gallstones or ERCP can cause 
cholangitis 
Mirizzi syndrome 
GB empyema 
Gallstone ileus
17
Q

What is a gallstone ileus?

A

gallstones pass into small bowel via cholecystoduodenal fistula
bowel obstruction, usually in terminal ileum

18
Q

What is a gallbladder empyema?

A

gall bladder filled with pus
patients are often septic
USS/CT then lap chole

19
Q

What is Mirizzi syndrome?

A

stone in Hartmaan’s pouch or cystic duct - compression of adjacent common hepatic duct
causing obstructive jaundice

20
Q

What is ascending cholangitis?

A

infection of the biliary tract

biliary outflow obstruction + biliary infection

21
Q

What causes ascending cholangitis?

A

anything causing occlusion of the biliary tree

  • gallstones
  • ERCP
  • cholangiocarcinoma
22
Q

How does ascending cholangitis present?

A

Charcot’s triad

  • RUQ pain
  • fever
  • jaundice (pale stool, dark urine)
23
Q

How is ascending cholangitis diagnosed?

A

LFTs - obstructive jaundice picture
USS - bile duct dilatation, gall stones
ERCP - diagnostic and therapeutic

24
Q

How is ascending cholangitis managed?

A

Iv access and fluid resus
manage any sepsis
broad spectrum antibiotics

ERCP (clear obstruction)

  • stenting
  • sphincterotomy
25
Q

Where is the most common site for cholangiocarcinoma?

A

bifurcation of R + L hepatic ducts

26
Q

What are risk factors for cholangiocarcinoma?

A

PSC, UC
hepatitis
HIV
alcohol excess

27
Q

What are clinical features of cholangiocarcinoma?

A

asymp. until later stage
obstructive jaundice
pruritus

uncommon: anorexia, malaise, RUQ pain, weight loss

28
Q

What are the investigations for suspected cholangiocarcinoma?

A 
cholestatic LFTs
USS - confirm obstruction 
MRCP/ERCP 
tumour marker - CA19.9 
CT staging
29
Q

What is the management of cholangiocarcinoma?

A

complete surgical resection - if early enough (majority of patients inoperative by the time they present)
radiotherapy

palliative

  • radiotherapy
  • stenting
  • surgery - if stenting doesnt work

GI and General Surgery (10 decks)

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