Gallbladder complications

Question 1

signs and symptoms are associated with cholecystitis

Answer 1

Epigastric pain that radiates to the right scapula
Pain and fullness that increases after a greasy or spicy meal
Fever
Tachycardia
Nausea

Question 2

diagnosing cholecystitis?

Answer 2

Abdominal ultrasound 
HIDA Scan (Hepatobiliary Iminodiacetic AciD scan)

Question 3

A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient?

Answer 3

The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods.

eg. Baked chicken with steamed carrots and rice

Question 4

Components of bile

Answer 4

Bilirubin, bile salts and cholesterol

Question 5

the presence of gallstones in the gallbladder

Answer 5

Cholelithiasis

Question 6

the presence of gallstones in the common bile duct

Answer 6

Choledocholithiasis

Question 7

Charcot’s triad

Answer 7

Abdominal pain, High fever, jaundice

Indicates cholangitis

Question 8

Reynold’s pentad?

Answer 8

Charcot cholangitis triad PLUS hypotension and mental status changes

Question 9

Elevated alk-phos suggests

Answer 9

Obstruction of the common bile duct caused by a gall stone

Question 10

ERCP Can cause?

Answer 10

Acute pancreatitis

Question 11

Gallstones are often asymptomatic T/F

Answer 11

True

Question 12

Acute cholecystitis? Tell me what you know

Answer 12

One of the most common complications of gallstones.
Stone becomes impacted in the cystic duct , leading to edema and inflammation
US: Gall bladder wall thickening and pericholecystic fluid
Clinically: Persistent RUQ pain, fever, leukocytosis

Question 13

Cholangitis?

Answer 13

Intermittent obstruction of common bile duct, allowing reflux of bacteria up the biliary tree, followed by development of purulent infection behind the obstruction.

Question 14

Pregnancy and gall stones?

Answer 14

Beginning in the third trimester of pregnancy, increased circulating estrogen levels result in an increased hepatic cholesterol synthesis and the formation of cholesterol-supersaturated bile. Moreover, higher progesterone levels cause smooth muscle relaxation, decreased and incomplete emptying of the gallbladder, and subsequent bile stasis. Together, cholesterol-rich lithogenic bile and gallbladder stasis predispose to gallstone formation. Similarly, hormone replacement therapy and oral contraceptive use also predispose to cholelithiasis.

Question 15

LFTs are ordered for two primary reasons:

Answer 15

To confirm clinical suspicion of potential liver injury or disease

To distinguish between hepatocellular injury (hepatic jaundice) and cholestasis (post-hepatic or obstructive jaundice)

Question 16

What blood tests are used to assess liver function?

Answer 16

Alanine transaminase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (ALP)
Gamma-Glutamyltransferase  (GGT)
Bilirubin
Albumin
Prothrombin time (PT)

ALT, AST, ALP and GGT are used to distinguish between hepatocellular damage and cholestasis. Bilirubin, albumin and PT are used to assess the liver’s synthetic function.

Question 17

alt/ast increase

Answer 17

hepatocellular damage

Question 18

alk-phos?

Answer 18

A markedly raised ALP with a raised GGT is highly suggestive of cholestasis.

If not, think bone

Question 19

What if the patient is jaundiced but ALT and ALP levels are normal?

Answer 19

An isolated rise in bilirubin is suggestive of a pre-hepatic cause of jaundice.

Causes of isolated jaundice include:

Gilbert’s syndrome (most common cause)
Haemolysis

Question 20

Liver functions

Answer 20

Conjugation and elimination of bilirubin
Synthesis of albumin
Synthesis of clotting factors
Gluconeogenesis

Question 21

The combination of the colour of urine and stools can give an indication as to the cause of jaundice:

Answer 21

Normal urine + normal stools = pre-hepatic cause
Dark urine + normal stools = hepatic cause
Dark urine + pale stools = post-hepatic cause (obstructive)

Unconjugated = normal urine = pre-hepatic

Unconjugated bilirubin is water-insoluble and therefore doesn’t affect the colour of the patient’s urine. Conjugated bilirubin, however, can pass into the urine as urobilinogen, causing the urine to become darker.

Question 22

Albumin

Answer 22

synthesised in the liver and helps to bind water, cations, fatty acids and bilirubin. It also plays a key role in maintaining the oncotic pressure of blood.

Question 23

Prothrombin time?

Answer 23

a measure of the blood’s coagulation tendency, specifically assessing the extrinsic pathway.

an increased PT can indicate liver disease and dysfunction.
(In the absence of other secondary causes such as anticoagulant drug use and vitamin K deficiency)