Gallbladder Flashcards
RF for gallstones
FFF, preg, rapid changes in weight, crohns (change in bile salt absorption in terminal ileum), haemolytic anaemias!
what is murphys sign
press under ribs on right side and breath in –> if pain which stops inspiratory effort –> murphys +
does biliary colic have a positive murphys sign
no
Mx of billiary colic
simple analgesics, low fat diet, increased exercise, offer elective laparoscopic cholecystectomy due to recurrence of symptoms
Presentation of acute cholecystitis
constant pain in RUQ and fever
is murphys sign positive in acute cholecystitis
yes
Mx of acute cholecystitis
IV abx, analgesia, antiemetics and laparoscopic cholecystectomy within one week
Ix for gallstones
Bloods - FBC, LFT (ALP will be raised for all biliary problems but liver only affected in obstructive) and CRP
US firstline
MRCP (magnetic resonance cholangopancreatography) if US negative
complications of cholecystectomy
stone retained in bile duct, damage post cholecystectomy syndrome, bile leak
what is post cholecystectomy syndrome
non specific symptoms which result from having reduced bile like diarrhoea, flatulance and intolerance of fatty food
incision for open cholecystectomy
kocher
what can cause ascending cholangitis apart from an obstructing stone in CBD
cholangiocarcinoma / pancreatic cancer in head of pancreas (basically anything which obstructs bile flow as stasis of flow allows bacteria to invade)
Or ERCP
complications of acute cholecystitis
1) mirizzi syndrome –> stone in the bile duct compresses the common hepatic duct so causes an obstructive jaundice even though there is no stone present in the duct
2) gall bladder empyema (pus in gb) –> this needs a cholestostomy and a cholecystectomy
3) fistula (cholecystoduodenal fistula) –> and then stones can obstruct either the proximal duodenum or cause a gallstone ileus (if they obstruct at the terminal ileum)
triad of symptoms in ascending cholangitis
jaundice, fever, RUQ pain
most common organisms in ascending cholangits
1) Ecoli 2) klebsiella
MX of ascending cholangtiits
ERCP - endoscopic retrograde cholangiopancreatography
what happens in a gallstone ileus
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)
what does an xray show on a gallstone ileus
pneumobilia (gas in the cbiliary tree) and dilated small bowel
where is cholangiocarcinoma most likely to affect
perihilar duct region
RF for cholangiocarcinoma
PSC
what is courvoisiers law
enlarged gallbladder and jaundice unlikely to be gallstones but more likely to be cholangiocarcinoma, gallbladder cancer or pancreatic cancer
how does cholangiocarcinoma present
similar to cancer in the head of the pancreas - RUQ pain, jaundice, cachexia
IX for cholangiocarcinoma
LFT, CA19-9, CT and biopsy, US may show dilation of ducts
MRCP IS GOLDSTANDARD
MX of cholangiocarcinoma
normally too advanced for surgery but can put stents in by ERCP
how does a patient with a gallbladder empyema present (This is a complication of cholecystitis)
tender mass in RUQ and often septic
MX of gallbladder empyema
drainage (cholecystostomy) and removal (cholecystectomy)
goldstandard IX for gallbladder cancer (this is rare so v unlikely to get a question on)
ERCP
RF for gallbladder cancer
gallstones, chronic cholecystitis, PSC
pathophysiology of appendicitis
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
what is the point called where you check for rebound tenderness
McBurneys point
what is psoas sign
lie patient on left side and extend right hip back –> cause pain (due to irritation of iliopsoas)
imaging for appendicitis
Dx can be made clinically, in women do US to check for pelvic pathology and in men may do a CT
apart from imaging other IX for appendicitis
urine dip, preg test, bloods (leucocytosis and raised cRP)
what is the debate of using lanz incision over gridiron for open appendectomy
lanz –> better cosmetically but risks injury the ilioinguinal nerve (which is sensory to labia and supplies motor to anterior abdominal muscles)
complications of acute appendicitis
perforation, SSI, appendiceal mass, pelvic abscess
what is an appendeceal mass
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
