Gallbladder, Liver, Pancreas

Question 1

Gallstones - causes/rf, syx, ix, mx

Answer 1

RF: Fat, Female, Fertile, Forty, FH, sudden wt loss, loss of bile salts (ileal resection) DM, oral contraceptives

Syx

• Asyx
• Biliary colic
• RUQ or epigastric pain: 30min-8hr duration, worse with fats, wake up at night, radiate to intrascapular region
• N+V

Ix

• Urinalysis, CXR, ECG - r/o other causes
• FBC, CRP, UE, LFT, amylase, clotting, G&S
• USS: confirm presences of gallstones via ‘acoustic shadowing’, absence does not exclude dx
• MRCP if USS fails to detect stones

Mx

• Asyx - no Rx
• Laparoscopic cholecystectomy

Question 2

Acute + Chronic Cholecystitis - what is it, syx, ix, mx

Answer 2

• Inflammation of cystic duct and gallbladder
• Repeated acute attacks lead to chronic cholecystitis, where the walls of the gallbladder become thickened and scarred so gallbladder becomes shrivelled

Syx
Acute
- Constant epi and RUQ pain - refers to right shoulder 
- N+V 
- Fever 
- +ve Murphy 

Chronic

• Syx similar but more mild
• Vague abdo discomfort
• Distention
• Nausea
• Fat intolerance

Ix

• FBC, CRP, LFT, UE, Amylase, Clotting, G&S, bHCG
• TA USS

Mx
Laparoscopic cholecystectomy

Question 3

What is charcot’s triad? Reynolds’ pentad

Answer 3

Indicates cholangitis. Triad of RUQ pain, jaundice, pyrexia

Reynolds’ pentad is above plus hypotension and a decreased level of consciousness , which indicates acute cholangitis in septic shock