Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Gall stones > Flashcards

Gall stones Flashcards

1
Q

What is cholelithiasis

A

Prescence of gall stones

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

What is choledocholthiasis

A

Presence of gall stones in common bile duct

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

How do gall stones form

A

Imbalance between ratio of cholesterol and bile pigments in bile
Too much cholesterol - age, obesity
Too much bilirubin - haemolysis
Not enough bile salts

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

What is cholesterolsis

A

Increased cholesterol in gall bladder forming HB polyps

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

What are the symptoms of gall stone

A

Asymptomatic (30%)
Dyspepsia
Loss of appetite

Biliary colic if stone gets stuck in CBD (RUQ pain radiating to back +- jaundice + N+V)
Colic last longer than obstruction

Sympyoms when stuck in CBD
Jaundice
Dark urine
Pale stool 
Pruritus  
Steattorhea

Exam

  • Scars as laparoscopic
  • HSM or palpable GP - suggest malignancy
  • Murphy’s for cholecystitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What suggests abscess

A

Hx RUQ pain

Swinging fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the RF for gall stones

A 
Age
Female
OCP
Obesity
DM
Pregnancy
Hyperlipidaemia
Haemolytic anaemia
Bile infection 
Low fibre, high fat
Rapid weight loss 
FH 
IBD - terminal ileal as affects absorption of bile salt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the complications of gallstones

A

If in bile duct

  • Obstructive jaundice
  • Cholangitis (bile duct)
  • Pancreatitis as enzymes back up
  • Cirrhosis

Gall bladder / cystic duct

  • Biliary colic
  • Cholecystits
  • Empyema
  • Obstruction
  • Mirizzis syndrome
  • Gall stone ileus

Empyema / abscess = emergency
Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Mirizzi

A

Gall stone in GB compresses CBD

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

What is gall stone ileus

A

Fistula between gall bladder and duodenum

Stone passes and obstructs

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

What are the Sx of gall stone ileus

A

HX gall stone
Abdominal pain
Distension
Vomit

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

How do you Dx gall stone ileus

A

Laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are cholendochal cysts

A

Remove as can be cancerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you Dx gall stone

What other investigations for Ddx

A

Blood -FBC, U+E, LFT, CRP, amylase
USS = 1st line
Standard workup
Do urinalysis, CXR and ECG for DDX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should you always do in renal / biliary colic in men

A

CT KUB

Assume AAA until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are signs suggesting AAA

A

Pulsatile and expnasile mass

Do aorta exam on every abdominal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should you do if suspect stone in CBD

A

MRCP
ERCP if going to remove
Not urgent if no cholangitis
Likely to cholecystectomy after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What will stones in CBD or hepatic duct cause

A

Jaundice

If in cystic or gall bladder = no jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you treat asymptomatic gall stones

A

Observe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you do if symptomatic / risk of complications

A

Rehydrate
NBM
Laparoscopic cholecystectomy = gold standard to remove gall bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is often found at cholecystectomy

A

Stones in CBD

Can remove at operation or early ERCP in days following

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What suggest stone in CBD

A

Ongoing RUQ pain / jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are other options if unfit

A

ORSO dissolution

UDCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What should you do before cholecystectomy

A

Urinanylsis
CXR
ECG

25
Q

What do you do to Dx and Rx for abscess

A

USS +- CT to Dx
CHolecystectomy
Drainage if unfit
Antibiotics

26
Q

What are the complications of cholecystectomy

A 
Pain
Haemorrhage - cystic artery
Infection
DVT
Bile leak
Bile duct injury / stricture - stent
27
Q

DDX for gall stone in CBD

A 
AAA
Stricture
Mirizzi
PSC
Pancreatitis
Pancreatic cancer
HIV
28
Q

What are symptoms if in CBD

A 
Dyspepsia 
Jaundice
RUQ Pain
Dark urine / pale stool / pruriitus
Steatthorea
N+V
Anoreixa
29
Q

How do you Dx stone in CBD

A 
LFT
ALP raised
Other bloods - WCC / CRP
USS = shows ductal dilatation
ERCP or MRCP
CT can see obstructive jaundice but not stones
30
Q

How do you treat stones in CBD

A

ERCP allow location and can do sphincterotomy / stone extraction
PTC (Percutaneous trans-hepatic cholangiogram) if can’t do this
MRCP if not going to remove stone
Follow by lap chole to remove gall bladder

31
Q

What are the complications of CBD

A

Same as gall stone

Cholangitis and pancreatitis more likely so always treat even if asymptomatic so if found at lap chole need to remove

32
Q

What is cholecystits

A

Inflammation of the gall bladder

33
Q

What causes cholecystitis

A

Stone in GB
Bile builds up and gets infected
Can get without stone if intercurrent illness e.g. DM / organ failure

34
Q

What are the symptoms of cholecystitis

A 
Continuous severe epigastric pain 
Can be colicky
Fever
Rigors
Vomiting
Local peritonism
Raised WCC / CRP
GB mass
Murphy = pathopneumonic 
No jaundice
35
Q

What is Murphy

A

Sensation of inspiration on palpation of RUQ

36
Q

What are signs of chronic cholecystitis

A 
Dyspepsia
Vague discomfort
DIstension
Nausea
Flatulence
Fat intolerance
Similar to IBS
37
Q

How do you Dx cholecystitis

A

USS = thick wall, stone, dilatation
ERCP
MRCP if not suitable but need to remove stone
Deranged LFT

38
Q

How do you Rx

A 
NBM
Pain relief
IV AX
Fluid
ERCP 
Lap chole within 7 days of ERCP to remove GB (don't do straight away)
39
Q

What do you do for chronic

A

ERCP and lap chole

40
Q

If symptoms persist post surgery what do you suspect

A 
Hiatus hernia
GORD
IBS
Peptic ulcer
Chronic pancreatitis
Tumour
41
Q

What are the complications of cholecysitis

A

Obstructive jaundice and cholangitis if moves to CBD

42
Q

What is cholangitis

A 
Infection of CBD
SURGICAL EMERGENCY
E.coli = most common
Klebsiella 
Usually precipitated by stone or ERCP
43
Q

What are the symptoms

A 
RUQ pain
Fever
JAundice 
Hypotension / confusion / 
Rigors
Empyema 
Sepsis
44
Q

What are the RF

A

Stone in CBD
PSC
Biliary tree dilatation

45
Q

How do you Dx

A

USS = dilatation / stone
Raised inflammatory
ERCP within 24-48 hours

46
Q

How do you Rx

A

IV Ax - amox, met, gent, cipro
Fluid resus
Correct coagulation
Early ERCP to relieve within 48 hours or PTC
Lap chole after as likely due to gall stones from gallbladder (within 1 week)

47
Q

What should you monitor for

A

Pancreatits

Gent levels

48
Q

When is ERCP indicated

A

Jaundice patient suspected as having obstruciton
Pancreatic/ biliary disease
Pancreatic malignancy requiring stent
Unknown aetiology

49
Q

When is it not indicated

A

NO obstruction

Abdo pain

50
Q

What do you give before ERCP

A

IV Ax to prevent cholangitis - co-amox
Stop anti-coagulant
Dicloefnac to reduce risk of pancreatitis

51
Q

What is risk of ERCP

A

Bleeding from sphincterotomy
CHolangitis
Pancreatitis
Perforation of bile duct or duodenum

52
Q

Why are gall stones symptoms worse after eating

A

CCK

Contraction

53
Q

If patient not responding to Ax in cholangitis what should you consider

A

Whether collection of pus e.g. gall bladder empyema

54
Q

Anatomy of biliary tree

A

Gall bladder into cystic duct
Liver into hepatic duct
Both join to form common bile duct
Join pancreatic duct at ampulla of Vader

55
Q

How do stones cause pancreatitis

A

Impact lower down in CBD and blocks of pancreatic duct

56
Q

When would you need to do an open cholecystectomy over a LC

A

Failed LC
Complications in LC
Complications of acute cholecystitis

57
Q

What are complications of cholecystectomy

A

Intra-abdo fluid collection / haematoma
Bile leak
Pancreatitis
Jaundice due to retained CBD stone or bile duct injury

58
Q

What are late complications

A

Strictures

59
Q

What causes pigmented gallstones

A

Anything that causes haemolytic as increased bilirubin

GI (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions