Gallbladder Flashcards
What are cholesterols, gallstones?
Cholesterol crystallisation from gallbladder bile
Cholesterol supersaturation of bile
Cystallization promoting factors within bile
Motility of the gallbladder itself
What are bile pigment stones?
Calcium bilirubina with less than 50% cholesterol content
Black stones- seen in patients with haemolytic conditions (sickle cell disease, spherocytosis)
Brown stones- presence of bile stasis and/or biliary infection. Common cause of recurrent bile duct stones following cholecystectomy
What are the risk factors for cholesterol gallstones?
Increasing age Female Multiparity Obesity Rapid weight loss Diet (high in animal fat) Drugs (contraceptive pill) Ileal disease or resection Diabetes Acromegaly treated with ocreotide Liver cirrhosis
How is biliary colic pain described?
Severe constant pain with crescendo characteristic
Symptoms related to over-indulgence of food
Mid-evening lasting to the early hours of the morning
Epigastrium and RUQ radiates to right shoulder and sub scapular region
What is acute cholecystitis?
Obstruction to gallbladder emptying
95% cases caused by a gallstone
Infection is a secondary response following vascular and inflammatory events
Pain associated with tenderness and muscle guarding or rigidity
What can be found in blood tests in cholecystitis?
Moderate leucocytosis
Raised CRP
Bilirubin, ALP and aminotransferase may be marginally elevated
What can an abdominal ultrasound of the gallbladder show?
Gallstones (gallbladder neck or cystic duct)
Focal tenderness over the underlying gallbladder
Thickening of the gallbladder wall (hypoalbuminaemia, portal hypertension, acute viral hepatitis)
What are the differential diagnoses for severe RUQ pain?
Cholecystitis Acute pancreatitis Perforated peptic ulcer Intrahepatic abscess Basal pneumonia Renal colic
When would a patient have an open cholecystectomy?
Extensive previous upper abdominal surgery
Ongoing bile duct obstruction
Portal hypertension
What are the complications of a cholecystectomy?
Biliary leak either from the cystic duct or from the gallbladder bed
Injury to the bile duct
Biliary sepsis and secondary biliary liver injury
What is found upon examination of patients with common bile duct stones?
May be no findings between episodes
Jaundiced, fever, associated tachycardia
Tenderness in RUQ
What investigations are done for bile duct stones?
Normal full blood count
Elevated neutrophil and raised ESR and CRP (cholangitis)
Raised serum bilirubin
ALP and y-glutamyl transpeptidase raised
Serum amylase levels raised
PT prolonged (bile duct obstruction), decreased absorption of vitamin K
What are the complications of gallstones?
Acute cholecystitis Acute cholangitis Gallstone related pancreatitis Biliary enteric fistula Ileus or true obstruction of small bowel Adenocarcinoma of the gallbladder
What is primary sclerosing cholangitis
Chronic cholestatic liver disease characterised by fibrosing inflammatory destruction of both the intra and extra hepatic bile ducts
In 75% of patients it’s associated with IBD (UC)
Fluctuating pruritus, jaundice and cholangitis
Diagnosed by ERC, MRCP and liver biopsy
Slowly progressive lesion leading to liver cirrhosis and decompensation
20% have complication of cholangiocarcinoma
Only treatment is liver transplantation
What are gallbladder polyps?
Non-neoplastic and are inflammatory in origin or composed of cholesterol deposits
Cholecystectomy recommended for any polyp 1cm of larger
