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Y5 colorectal > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

RF for gallstones

A

FFF, preg, rapid changes in weight, crohns (change in bile salt absorption in terminal ileum)

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2
Q

what is murphys sign

A

press under ribs on right side and breath in –> if pain murphys +

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3
Q

does biliary colic have a positive murphys sign

A

no

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4
Q

Mx of billiary colic

A

simple analgesics, low fat diet, increased exercise, offer elective laparoscopic cholecystectomy due to recurrence of symptoms

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5
Q

Presentation of acute cholecystitis

A

constant pain in RUQ and fever

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6
Q

is murphys sign positive in acute cholecystitis

A

yes

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7
Q

Mx of acute cholecystitis

A

IV abx, analgesia, antiemetics and laparoscopic cholecystectomy within one week

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8
Q

Ix for gallstones

A

Bloods - FBC, LFT and CRP
US firstline
MRCP (magnetic resonance cholangopancreatography) if US negative

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9
Q

complications of cholecystectomy

A

stone retained in bile duct, damage post cholecystectomy syndrome

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10
Q

what is post cholecystectomy syndrome

A

non specific symptoms which result from having reduced bile like diarrhoea, flatulance and intolerance of fatty food

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11
Q

incision for open cholecystectomy

A

kocher

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12
Q

what can cause ascending cholangitis apart from an obstructing stone in CBD

A

cholangiocarcinoma / pancreatic cancer in head of pancreas (basically anything which obstructs bile flow as stasis of flow allows bacteria to invade)

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12
Q

complications of acute cholecystitis

A

gallbladder empyema and perforation and fistula formation (cholecystoduodenal fistula)

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13
Q

triad of symptoms in ascending cholangitis

A

jaundice, fever, RUQ pain

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14
Q

most common organisms in ascending cholangits

A

1) Ecoli 2) klebsiella

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15
Q

MX of ascending cholangtiits

A

ERCP - endoscopic retrograde cholangiopancreatography

16
Q

what happens in a gallstone ileus

A

gallstone gets into the small bowel via a fistula (cholecystoduodenal fistula) after acute cholecystitis. It then get trapped in the small bowel in narrowest part (terminal ileum/ileocaecal valve)

17
Q

what does an xray show on a gallstone ileus

A

pneumobilia and dilated small bowel

18
Q

where is cholangiocarcinoma most likely to affect

A

perihilar duct region

19
Q

RF for cholangiocarcinoma

A

PSC

20
Q

what is courvoisiers law

A

enlarged gallbladder and jaundice unlikely to be gallstones but more likely to be cholangiocarcinoma, gallbladder cancer or pancreatic cancer

21
Q

how does cholangiocarcinoma present

A

similar to cancer in the head of the pancreas - RUQ pain, jaundice, cachexia

22
Q

IX for cholangiocarcinoma

A

LFT, CA19-9, CT and biopsy, MRCP

23
Q

MX of cholangiocarcinoma

A

normally too advanced for surgery but can put stents in by ERCP

24
Q

how does a patient with a gallbladder empyema present (This is a complication of cholecystitis)

A

tender mass in RUQ and often septic

25
Q

MX of gallbladder empyema

A

drainage (cholecystostomy) and removal (cholecystectomy)

26
Q

goldstandard IX for gallbladder cancer (this is rare so v unlikely to get a question on)

A

ERCP

27
Q

RF for gallbladder cancer

A

gallstones, chronic cholecystitis, PSC

28
Q

pathophysiology of appendicitis

A

luminal obstruction by faecolith / lymphoid hyperplasia causes stasis of fluid which allows commensal bacterias to multiply. This causes inflammation which then impedes venous drainage, increasing pressure and can eventually lead to ischaemia

29
Q

what is the point called where you check for rebound tenderness

A

McBurneys point

30
Q

what is psoas sign

A

lie patient on left side and extend right hip back –> cause pain (due to irritation of iliopsoas)

31
Q

imaging for appendicitis

A

Dx can be made clinically, in women do US to check for pelvic pathology and in men may do a CT

32
Q

apart from imaging other IX for appendicitis

A

urine dip, preg test, bloods (leucocytosis and raised cRP)

33
Q

what is the debate of using lanz incision over gridiron for open appendectomy

A

lanz –> better cosmetically but risks injury the ilioinguinal nerve (which is sensory to labia and supplies motor to anterior abdominal muscles)

34
Q

complications of acute appendicitis

A

perforation, SSI, appendiceal mass, pelvic abscess

35
Q

what is an appendeceal mass

A

in acute appendicitis when the momentum and small bowel adhere to the appendix. It is normally treated conservatively with IVabx due to high risk of visceral injury

Y5 colorectal (8 decks)

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