Gallbladder Pathology Flashcards
Who are most likely to get gallstones?
Fair haired Female Fat >40yo COCP DM
What are the different compositions of gallstones?
Cholesterol (80%)
Pigment
Mixed
How are gallstones investigated?
- Bloods: ↑WCC, ↑CRP, LFTs (↑ALP, ↑Bili- if jaundiced)
- USS Abdo: Visualise stone
- MRCP: Determine point of obstruction
How is biliary colic characterised?
Sudden RUQ pain Radiating to R shoulder Persists for 15mins Better w/analgesia N&V
How does acute cholecystitis present?
Constant colicky RUQ pain Radiates to back/shoulder Worse when eating fatty foods RUQ tenderness \+ve MURPHY'S sign Fever, N&V, bloating Obstructive jaundice
How is chronic cholecystitis characterised?
Vague abdo discomfort + distension
Nausea
Flatulence
Fat intolerance
Why do fatty foods cause worsening abdo pain in cholecystitis?
Fat stimulates cholecystokinin release = contraction of gallbladder
How is biliary colic treated?
Analgesia
Rehydration- NBM
Elective laparoscopic cholecystectomy
How is acute cholecystitis treated?
- Analgesia, rehydrate, NBM
- Abx – Co-Amoxiclav (control any infection first)
- Laparoscopic cholecystectomy – within 1 week!!
- Open cholecystectomy – if GB perforation
How is chronic cholecystitis treated?
- If US shows dilated CBD w/ stones → ERCP + sphincterotomy before cholecystectomy
- Laparoscopic cholecystectomy (Definitive)
What is Gilbert syndrome?
Autosomal recessive disorder
ISOLATED ↑↑Bilirubin all other LFTs normal
Follows simple URTI
NO Tx REQUIRED
What is the clinical presentation of cholangitis?
CHARCOT’S TRIAD: Fever/Rigors + Jaundice + RUQ pain
Other:
N&V
Hx of gallstones
How is cholangitis investigated?
- Bloods: FBC (↑WCC, ↑Neut), ↑ESR, ↑CRP, LFTs (↑Bili, ↑↑ALP, ↑ALT), ↑INR, Amylase N (exclude pancreatitis)
- Abdo USS: Biliary dilatation
- MRCP
- Contrast CT
What is the management for cholangitis?
SEPSIS bundle
IV fluids
Broad Spec Abx- IV Cefuroxime + Metronidazole
ERCP w/sphincterotomy AFTER 24-48hrs TO RELIEVE OBSTRUCTION
What is cholangitis?
Bacterial infection of the biliary tract as a result of obstruction
What is Reynold’s pentad?
Charcot’s triad plus:
- Hypotension
- Confusion
Where is a suphrenic abscess found?
Localised collection of pus
Underneath R or L semi-diaphragm
When is a subphrenic abscess likely to occur?
As a result of generalised peritonitis following: Acute appendicitis Perforated PU Perforated Gallbladder Bowel surgery
How does a subphrenic abscess present?
Typically features of toxicity 2-21days post-op/peritonitis
N&V
Malaise
Abdo tenderness in subcostal region
Upper abdo pain radiating to shoulder tip
Dyspnoea = Lobe collapse
How is a subphrenic abscess investigated?
Bloods: ↑WCC
US/CT: Visualise pus
CXR: High diaphragm on affected side
How does a liver abscess present?
Swinging pyrexia + Night sweats
RUQ pain + tenderness- radiates to shoulder
Hepatomegaly + abdo mass
N&V
Cough & dyspnoea- diaphragmatic irritation
What are the most common causes of a liver abscess?
Pyogenic = Most common in UK Amoebic = Most common worldwide
What are the causes of a pyogenic abscess?
Secondary infection of abdomen: Caused by: Klebsiella, E.Coli, Staph Aureus -Ascending cholangitis -Appendicitis -CD -PUD -Diverticulitis
What can a pyogenic abscess be a complication of?
Liver biospy
Blocked biliary stent
Endocarditis
Dental infection
