gall stones and cholangiocarcinoma Flashcards
what are gall stones and where do they come from ?
Stones form in the biliary system.
Imbalance between ratio of cholesterol and bile salts disruption micelle formation.
what are risk factors for gall stones ?
5 F’s
fat
fair
female
fertile
forty
how do gallstones present ?
Biliary colic - wax/weaning postprandial epigastric/RUQ pain due to transient cystic duct obstruction, no signs of infection.
what is chronic cholecystitis ?
recurrent bouts of biliary colic leading to chronic GB wall inflammation/fibrosis.
how does chronic cholecystitis present ?
Painful post hepatic jaundice.
No signs of infection.
what is acute cholecytisis ?
acute GB distension, wall inflammation and oedema due to cystic duct obstruction.
how does acute cholecytisis present ?
RUQ pain that can refer to right shoulder +/- fever.
Murphys sign - press hand below right costal margin, hold breath, won’t be able to take a deep breath.
what is Murphys sign and what is it associated with ?
Murphys sign - press hand below right costal margin, hold breath, won’t be able to take a deep breath.
associated sign with acute cholecystitis
how would you investigate for gallstones and what would you look for ?
US 1st line: look for gallstones, distended gallbladder, biliary tree dilatation, increased wall thickness, peri-cholecystic fluid.
how would you manage gallstones biliary colic ?
NG tube if vomiting, IV fluids, analgesia, antibiotics for cholecystitis.
how would you differentiate between GB colic and acute cholecystitis ?
Suspect GB colic in patients with RUQ pain of less than 4-8 hours radiating to back.
Consider acute cholecystitis in those with longer duration of pain, with or without fever.
how would you manage gallstones ?
ABCDE
medical management for biliary colic
surgery
when would you do surgery for gallstones ?
early cholecystectomy for acute cholecystitis.
what is choledocholithiasis ?
the presence of gallstones in the common bile duct
what is ERCP used for ?
Choledocholithiasis
what is cholangiocarcionoma ?
cancer of the biliary tree
what causes cholangiocarcinoma ?
PSC, biliary cysts, HBV, HCV, DM,
how does cholangiocarcinoma present ?
fever, abdominal pain, malaise, raised bilirubin, raised ALP +/- ascites.
courvoisiters law
what would you do to investigate for cholangiocarcinoma ?
Bloods - FBC, clotting, LFTs, hepatitis serology.
Imaging - ERCP and biopsy if cholangiocarcinoma suspected.
how would you manage cholangiocarcinoma ?
Most inoperable at presentation. Most of those that are operable recur.
Surgery - major hepatectomy and extrahepatic bile duct excision and caudate lobe resection.
Stenting of obstructed extrahepatic biliary tree, percutaneously or via ERCP.
Very poor prognosis
how would you manage cholangiocarcinoma ?
Most inoperable at presentation. Most of those that are operable recur.
Surgery - major hepatectomy and extrahepatic bile duct excision and caudate lobe resection.
Stenting of obstructed extrahepatic biliary tree, percutaneously or via ERCP.
Very poor prognosis
