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Yr 5 GI & Breast > Gallbladder Pathology > Flashcards

Gallbladder Pathology Flashcards

1
Q

Who are most likely to get gallstones?

A 
Fair haired
Female
Fat
>40yo
COCP
DM
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2
Q

What are the different compositions of gallstones?

A

Cholesterol (80%)
Pigment
Mixed

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3
Q

How are gallstones investigated?

A
  • Bloods: ↑WCC, ↑CRP, LFTs (↑ALP, ↑Bili- if jaundiced)
  • USS Abdo: Visualise stone
  • MRCP: Determine point of obstruction
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4
Q

How is biliary colic characterised?

A 
Sudden RUQ pain
Radiating to R shoulder
Persists for 15mins
Better w/analgesia
N&V
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5
Q

How does acute cholecystitis present?

A 
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
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6
Q

How is chronic cholecystitis characterised?

A

Vague abdo discomfort + distension
Nausea
Flatulence
Fat intolerance

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7
Q

Why do fatty foods cause worsening abdo pain in cholecystitis?

A

Fat stimulates cholecystokinin release = contraction of gallbladder

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8
Q

How is biliary colic treated?

A

Analgesia
Rehydration- NBM
Elective laparoscopic cholecystectomy

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9
Q

How is acute cholecystitis treated?

A
  1. Analgesia, rehydrate, NBM
  2. Abx – Co-Amoxiclav (control any infection first)
  3. Laparoscopic cholecystectomy – within 1 week!!
  4. Open cholecystectomy – if GB perforation
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10
Q

How is chronic cholecystitis treated?

A
  1. If US shows dilated CBD w/ stones → ERCP + sphincterotomy before cholecystectomy
  2. Laparoscopic cholecystectomy (Definitive)
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11
Q

What is Gilbert syndrome?

A

Autosomal recessive disorder
ISOLATED ↑↑Bilirubin all other LFTs normal
Follows simple URTI
NO Tx REQUIRED

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12
Q

What is the clinical presentation of cholangitis?

A

CHARCOT’S TRIAD: Fever/Rigors + Jaundice + RUQ pain

Other:
N&V
Hx of gallstones

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13
Q

How is cholangitis investigated?

A
  • Bloods: FBC (↑WCC, ↑Neut), ↑ESR, ↑CRP, LFTs (↑Bili, ↑↑ALP, ↑ALT), ↑INR, Amylase N (exclude pancreatitis)
  • Abdo USS: Biliary dilatation
  • MRCP
  • Contrast CT
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14
Q

What is the management for cholangitis?

A

SEPSIS bundle
IV fluids
Broad Spec Abx- IV Cefuroxime + Metronidazole
ERCP w/sphincterotomy AFTER 24-48hrs TO RELIEVE OBSTRUCTION

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15
Q

What is cholangitis?

A

Bacterial infection of the biliary tract as a result of obstruction

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16
Q

What is Reynold’s pentad?

A

Charcot’s triad plus:

  • Hypotension
  • Confusion
17
Q

Where is a suphrenic abscess found?

A

Localised collection of pus

Underneath R or L semi-diaphragm

18
Q

When is a subphrenic abscess likely to occur?

A 
As a result of generalised peritonitis following:
Acute appendicitis
Perforated PU
Perforated Gallbladder
Bowel surgery
19
Q

How does a subphrenic abscess present?

A

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

20
Q

How is a subphrenic abscess investigated?

A

Bloods: ↑WCC
US/CT: Visualise pus
CXR: High diaphragm on affected side

21
Q

How does a liver abscess present?

A

Swinging pyrexia + Night sweats
RUQ pain + tenderness- radiates to shoulder
Hepatomegaly + abdo mass
N&V
Cough & dyspnoea- diaphragmatic irritation

22
Q

What are the most common causes of a liver abscess?

A 
Pyogenic = Most common in UK
Amoebic = Most common worldwide
23
Q

What are the causes of a pyogenic abscess?

A 
Secondary infection of abdomen:
Caused by: Klebsiella, E.Coli, Staph Aureus
-Ascending cholangitis
-Appendicitis
-CD
-PUD
-Diverticulitis
24
Q

What can a pyogenic abscess be a complication of?

A

Liver biospy
Blocked biliary stent
Endocarditis
Dental infection

25
Q

How is a pyogenic abscess treated?

A

1) Cefotaxime + Metronidazole +/- Cipro

CT/US guided percutaneous drainage

26
Q

Describe an amoebic abscess

A 
Entamoeba Histolytica
Faecal-oral transmission
COMMONLY R LOBE
1) Metronidazole
2) CT/USS guided drainage
27
Q

What is a specific investigation for an amoebic abscess?

A

Stool: E. Histolytica +ve & Serology +ve

Yr 5 GI & Breast (13 decks)

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