gallbladder stotnes part 2

Question 1

what is choledocholithiasis and presentation

Answer 1

stones in the CBD causing extrahepatic obstruction.

persistent RUQ pain radiating to epigastrium or back after fatty meals.
signs of cholestasis: jaundice, pale stool, dark urine, pruritis. N/V

Question 2

diagnosis and treatment of choledocholithiasis?

Answer 2

LFTs: high GGT, ALP, total and direct bilirubin (means cholestasis)

to rule out other differentials:
CBC: high WBC in cholecystitis and cholangitis
amylase, lipase: high in biliary pancreatitis

abdominal ultrasound: dilated CBD
MRCP can be done but ERCP is gold standard for diagnosis and tx. if failed: do open surgery.
complication of ERCP: acute pancreatitis

Question 3

definition and causes of acute (ascending) cholangitis

Answer 3

obstruction of CBD with infection of bile ducts.
causes:
-choledocholithiasis
-malignancy (cholangiocarcinoma/ pancreatic cancer)
-biliary stricture (congenital, infectious, iatrogenic from ERCP/stent)
-extrinsic compression (like mirizzi syndrome)

Question 4

symptoms of acute cholangitis?

Answer 4

charcot triad: RUQ pain, high fever, jaundice

reynold pentad: charcot triad plus altered mental status and hypotension

con progress to septic shock

Question 5

diagnosis and tx of acute cholangitis

Answer 5

CBC: high WBC
cholestasis: high direct and total bilirubin, high GGT, ALP
high CRP

initial imaging test: US
obstructed CBD
narrow bile ducts (stricture)
biliary tumor
confirmatory imaging with CT contrast or MRI/MRCP

tx: IV antibiotics and ERCP to relieve obstruction/ tx the underlying cause