Gall bladder and such Flashcards
What are the signs of cholestasis?
- Jaundice
- itching
- RUQ intermittent pain
- acute or chronic
- ?painless
- dark brown urine
- pale/white stool
- weight loss
- lethargy
What bloods tests do you do for cholestasis Sx?
-bloods: LFTs - high bilirubin -alk phos - most important for gall bladder disease (choleliathsis not cyctisis) -ALT will go up -GGT- not specific
What does an isolated bilirubin w/o signs?
-gilberts syndrome - autosomal dominant abnomrality in bilirubin metabolism
Why do gallstones form?
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.
What Sx do gall stones cause?
- 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
what’s the symptomatic and examination difference between normal gallstones and cholecystitis?
- may have signs of sepsis
- biliary pain is progressive
- Hx of previous gall stones
- Murphy’s sign positive in cholecystisis
What would you find on tests for a patient with cholecytsitis?
- increased WBC count
- increased CRP
- USS - thick inflamed GB
- MRCP - better visualise the CBD
DDx for acute cholecystitis.
- Pancreatitis
- Appendicitis
- peptic ulcer disease
- liver abscess
- pneumonia
- ?MI
- perforated bowel
How does cholangitis differ from cholecystitis?
Cholangitis is an ascending infection of the CBD.
Occurs due to a blockage of the CBD and can happen without a gall bladder.
What are the symptoms of Ascending cholangitis?
-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 do you treat ascending cholangitis?
- ERCP
- Abx - Co-amoxiclav
What is primary sclerosing cholangitis?
- autoimmune inflammation of all the bile ducts
- 80% have ulcerative colitis too
- yearly colonoscopy because high risk bowel Ca
presentation of PSC?
- fatigue
- pruritis
- anorexia
- indegestion
- jaundice = late complication
Bloods for PSC?
- alk phos = sustained rise
- autoantibodies - +ve P-ANCA or +ve ANA
- test for IgM too
Tx for PSC?
- ultimately liver transplant - when starts sclerosing and before Ca because not fit for transplant then
- ?ciprofloxacin acute bacterial infection
- ursodeoxycholic acid
- anti-puritics