Gallbladder Disorders Flashcards
define cholelithiasis (gallstones)
presence of one or more gallstones in the gallbladder or other parts of the biliary tree
causes of gallstones
arise due to issues with chemical composition of bile (e.g. cholesterol supersaturation and gallbladder motility)
types of gallstones
pigment stones
cholesterol stones
mixed stones
risk factors of gallstones
crohns disease diabetes obesity NAFLD female sex
clinical features of gallstones
mostly asymptomatic but can present with intermittent RUQ/epigastric pain and nausea + vomiting
what are characteristics of pain due to gallstones
often associated with eating large/fatty meals
typically occurs in mid-evening until morning
does location of gallstones affect presentation?
YES! those in cystic duct/gallbladder will not cause abnormal lab results but those in common bile duct will
differentials of gallstones
acute hepatitis
GORD
peptic ulcer
IBD/IBS
investigations of gallstones
US of gallbladder
AXR
LFTs on bloods
management of gallstones if asymptomatic
provide reassurance that do not require treatment unless develop symptoms
explain commonality
provide prophylactic treatment
management of gallstones if symptomatic
IV morphine and antiemetic
elective cholecystectomy
common complications of gallstones
acute cholecystitis
acute pancreatitis
obstructive jaundice
choledocolithiasis
definition of cholecystitis
an inflammation of the gallbladder due to cholelithiasis that can develop to infection
infective causes involved in cholecystitis
e.coli
klebsiella
enterococcus
risk factors in cholecystitis
obesity
female sex
diabetes
increasing age
clinical features of cholecystitis
RUQ/epigastric pain (radiates to right shoulder) RUQ tenderness fever nausea + vomiting \+ve Murphys sign
differentials of cholecystitis
gallstones peptic ulcer disease acute cholangitis hepatitis pancreatitis
clinical features of cholecystitis WITH biliary obstruction
jaundice
dark urine
pale stools
classic cholecystitis symptoms
investigations for cholecystitis
US - thickened GB wall and pericholecystic fluid in GB/GB wall
bloods - raised WCC and abnormal LFTs
management of cholecystitis
cholecystectomy supportive care (e.g. nil by mouth, IV fluids, antibiotics and analgesia)
common complications of cholecystitis (untreated)
necrosis of gallbladder wall
perforation of the gallbladder
biliary peritonitis
jaundice
define cholangitis
an inflammation of the bile duct that can ascend into the biliary tree
- commonly caused by bacterial infection
- 2nd to gallstones in some cases
causes of cholangitis
obstruction of biliary tree (2nd to gallstones)
infection post-ERCP
malignant invasion
roundworm or liverfluke infection
risk factors of cholangitis
ERCP operation
HIV +ve status
cholangiocarcinoma
pancreatic/liver cancer
clinical features of cholangitis
charcots triad: jaundice fever RUQ pain \+ve Murphys sign reynolds pentad
differentials of cholangitis
diverticular disease hepatitis pancreatitis cirrhosis liver failure
investigations of cholangitis
abdominal US
AXR
contrast enhanced CT
ERCP
blood results of cholangitis
⬆️ WCC, LFTs, ESR + CRP
abnormal U+E and RFTs
blood cultures
management of cholangitis
prompt IV fluids, antibiotics and catheterisation
elective ERCP or cholecystectomy
common complications of cholangitis
septic shock
intra-abdominal collection
