Gallbladder disease Flashcards

1
Q

What does bile contain

A

Water
Cholesterol
Bile pigments
Phospholipids

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2
Q

How is bile secreted by gallbladder

A

Bile produced in liver
Then stored and concentrated in gallbladder

Lipid rich food in duodenum stimulates CCK release which causes Gallbladder contraction. Bile passes from the hallbladder into the duodenum

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3
Q

What results in gallstone formation

A

Supersaturation of bile

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4
Q

factors which contribute to gallstone formation

A

Cholesterol supersaturation.

  • Caused by increased plasma oestrogen [female, forty, fat, fair, fertile (one or more children), + fam history)
  • Caused by depletion of the bile acid pool –> terminal ileum resection or disease

Stasis of bile
-Lack of stimulus to GB emptying (fasting, TPN)

Increased Hb breakdown
-Haemolytic disorders (spherocytosis, sickle cell or malaria)

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5
Q

What are the 3 gallstone compositions

A

Cholesterol (often solitary, smooth, large)

Mixed (predominantly cholesterol, multiple, generations range of colours and shapes)

Pigment (bile pigments, multiple, small, irregular and fragile)

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6
Q

What is cholelithiasis

A

Stones in the gallbladder

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7
Q

What is choledocholithiasis

A

Stones in the bile duct

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8
Q

What is cholestasis

A

reduction or stoppage of bile flow

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9
Q

What is biliary colic

A

when cystic duct becomes impacted by gallstone

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10
Q

Pain of biliary colic

A

Sudden, sharp, stabbing, RUQ- epigastric pain. Typically radiates to right shoulder and lasts <6h

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11
Q

Associations of pain of biliary colic

A

Eating (esp fatty foods)

Associated N&V

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12
Q

Examination findings of biliary colic

A

Apyrexial. typically unremarkable

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13
Q

Investigations nad management of biliary colic

A

Stones on USS

-Ultrasound, outpatient cholecystectomy

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14
Q

IS jaundice present in biliary colic

A

No as bile can still drain via common bile duct

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15
Q

What is cholecystitis

A

Stone impacted in neck go gallbladder or cystic duct results in super concentrate, irritant. Bile can get infected by ascending gut bacteria (klebsiella, e.coli)

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16
Q

What bacteria can cause infections in cholecystitis

A

Klebsiella

E. coli

17
Q

Pain and associations in cholecystitis

A

Pain- constant RUQ- epigastric pain which persists. Main radiate to right shoulder

Associations- may babe N&V. Likely to have fever and or lethargy

18
Q

Examination findings in cholecystitis

A

Tender RUQ with possible guarding.

Murphy’s sign - Whilst applying pressure in RUQ ask patient to inspire deeply. Positive when there is a halt in inspiration due to pain. Similar manoeuvre in LUQ should not elicit discomfort

19
Q

Investigation findings in cholecystitis

A

Raised inflammation markers

Mildly raised AST/ALT/ALP

May have slightly raised bilirubin

USS shows enlarged gall bladder with stones and thickened walls

20
Q

Management of cholecystitis

A
Analgesia
Nil by mouth
IV fluids
Cholecystectomy within one week
Antiemetics if required 
Antibiotics (cef + met)
21
Q

Are patients jaundiced in cholecystitis

A

No

22
Q

What is cholangitis

A

Biliary outflow obstruction and ascending infection

23
Q

What pain and associations are there in cholangitis

A

RUQ, persistent, colicy in nature?

Jaundiced, typically unwell and pyrexial with rigors
-May also have pruritus, pale stool and dark urine. Often causes sepsis

24
Q

Examination findings in cholangitis

A

Tender RUQ with possible guarding. Pyrexial. Jaundiced.

25
Q

Investigation finding in cholangitis

A

raised WCC, blood cultures
Raised bilirubin
Raised ALP/GGT> AST/ALT
USS shows dilated bile ducts and/or gall bladder stones and/or ductal stones

26
Q

Management of cholangitis

A

Analgesia,
Nil by mouth
IV antibiotics
ERCP

27
Q

What blood tests to do if suspect gallbladder disease

A

FBC, U&E, LFT, CRRP, amylase

VBG+ blood cultures –> cholangitis

28
Q

What imaging options to use if ultrasound is inconclusive

A

CT scan
MRCP - detailed visualisation of biliary tree
ERCP- Contrast passed into biliary tree so you. can see. Whilst there, can unblock common bile duct. Gold standard for cholangitis

29
Q

What is a T tube and why is it used

A

Used if ERCP fails in cholangitis

  • Prevents common bile duct blockage due to swelling
  • Prevents bile leakage into Abdo cavity
  • Not reco. ended for routine use
30
Q

Wn a patient with painless jaundice and enlarged gallbladder what Is the likely cause

A

Obstructing malignancy until proven otherwise

31
Q

What is gallstone ileus

A

Inflammation of the gallbladder can cause a fistula between the gallbladder wall and the duodenum allowing gallstones to pass into the small bowel directly. if a stone impacts a terminal ileum this results in small bowel obstruction.