Gallbladder complications Flashcards
signs and symptoms are associated with cholecystitis
Epigastric pain that radiates to the right scapula
Pain and fullness that increases after a greasy or spicy meal
Fever
Tachycardia
Nausea
diagnosing cholecystitis?
Abdominal ultrasound HIDA Scan (Hepatobiliary Iminodiacetic AciD scan)
A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient?
The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods.
eg. Baked chicken with steamed carrots and rice
Components of bile
Bilirubin, bile salts and cholesterol
the presence of gallstones in the gallbladder
Cholelithiasis
the presence of gallstones in the common bile duct
Choledocholithiasis
Charcot’s triad
Abdominal pain, High fever, jaundice
Indicates cholangitis
Reynold’s pentad?
Charcot cholangitis triad PLUS hypotension and mental status changes
Elevated alk-phos suggests
Obstruction of the common bile duct caused by a gall stone
ERCP Can cause?
Acute pancreatitis
Gallstones are often asymptomatic T/F
True
Acute cholecystitis? Tell me what you know
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
Cholangitis?
Intermittent obstruction of common bile duct, allowing reflux of bacteria up the biliary tree, followed by development of purulent infection behind the obstruction.
Pregnancy and gall stones?
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.
LFTs are ordered for two primary reasons:
To confirm clinical suspicion of potential liver injury or disease
To distinguish between hepatocellular injury (hepatic jaundice) and cholestasis (post-hepatic or obstructive jaundice)
What blood tests are used to assess liver function?
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.
alt/ast increase
hepatocellular damage
alk-phos?
A markedly raised ALP with a raised GGT is highly suggestive of cholestasis.
If not, think bone
What if the patient is jaundiced but ALT and ALP levels are normal?
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
Liver functions
Conjugation and elimination of bilirubin
Synthesis of albumin
Synthesis of clotting factors
Gluconeogenesis
The combination of the colour of urine and stools can give an indication as to the cause of jaundice:
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.
Albumin
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.
Prothrombin time?
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)
