Gall bladder and such Flashcards

1
Q

What are the signs of cholestasis?

A
  • Jaundice
  • itching
  • RUQ intermittent pain
  • acute or chronic
  • ?painless
  • dark brown urine
  • pale/white stool
  • weight loss
  • lethargy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What bloods tests do you do for cholestasis Sx?

A
-bloods:
LFTs - high bilirubin
-alk phos - most important for gall bladder disease (choleliathsis not cyctisis)
-ALT will go up 
-GGT- not specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does an isolated bilirubin w/o signs?

A

-gilberts syndrome - autosomal dominant abnomrality in bilirubin metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why do gallstones form?

A

stasis of bile that has a high amount of cholestrol in.

Cholestrol causes precipitation of stones. Or pigment stones caused by increase turn over of RBC, haemolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What Sx do gall stones cause?

A
  • Epigastric pain to RUQ
  • RUQ pain radiates to the R shoulder/scapula
  • COLIC - 30 mins to 5 hrs - comes and goes
  • post prandial pain (after eating because GB is preparing to squeeze out bile for digestion)
  • nocturnal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what’s the symptomatic and examination difference between normal gallstones and cholecystitis?

A
  • may have signs of sepsis
  • biliary pain is progressive
  • Hx of previous gall stones
  • Murphy’s sign positive in cholecystisis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would you find on tests for a patient with cholecytsitis?

A
  • increased WBC count
  • increased CRP
  • USS - thick inflamed GB
  • MRCP - better visualise the CBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DDx for acute cholecystitis.

A
  • Pancreatitis
  • Appendicitis
  • peptic ulcer disease
  • liver abscess
  • pneumonia
  • ?MI
  • perforated bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does cholangitis differ from cholecystitis?

A

Cholangitis is an ascending infection of the CBD.

Occurs due to a blockage of the CBD and can happen without a gall bladder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms of Ascending cholangitis?

A

-painful jaundice
-Charcots triad:
Fever, Jaundice and RUQ pain. (obstructive jaundice)
-Can progress to Renold’s pentad:
charcot’s triad + hypotension + atlered mental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how do you treat ascending cholangitis?

A
  • ERCP

- Abx - Co-amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is primary sclerosing cholangitis?

A
  • autoimmune inflammation of all the bile ducts
  • 80% have ulcerative colitis too
  • yearly colonoscopy because high risk bowel Ca
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

presentation of PSC?

A
  • fatigue
  • pruritis
  • anorexia
  • indegestion
  • jaundice = late complication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bloods for PSC?

A
  • alk phos = sustained rise
  • autoantibodies - +ve P-ANCA or +ve ANA
  • test for IgM too
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx for PSC?

A
  • ultimately liver transplant - when starts sclerosing and before Ca because not fit for transplant then
  • ?ciprofloxacin acute bacterial infection
  • ursodeoxycholic acid
  • anti-puritics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What’s the similarities and differences between primary billary cholangitis (PBC) and primary sclerosing cholangitis (PSC)?

A

They’re both autoimmune disorders.

  • Primary Billary Cholangitis (B IS NOT FOR BOIS OR BODIES) is more common in middle aged women and is associated with hashimoto’s, grave’s, RA,
  • Primary Sclerosing Cholangitis is more associated with younger men and is associated with UC
17
Q

How do you treat primary billary cholangitis?

A
  • ursodeoxycholic acid
  • anti-puritic - anti-histamines
  • liver transplant is curative