Gallbladder stuff Flashcards
What is Cholelithiasis?
gallstones
What is a gallstone?
Hard stone/gravel-like material within the biliary system
Cholelithiasis can cause…?
Colic
Cholcystitis
Jaundice
Pancreatic & bowel obstruction
Gallstones are more common in?
Women Older age (both sexes)
What are the different categories of gallstones?
MixedCholesterol
Pigmented
Primary diet stone
Cholesterol gallstones are caused by?
Excess cholesterol
Pigmented gallstones are caused by?
Excess bilirubin
What are the risk factors for gallstones
Faorty Female Fatty diet Fat Fertile (pregnancy \+ hyperlipidaemia, bile salt loss (Crohn's), diabetes, dysmotility of gallbladder, prolonged fasting, TPN
What does TPN stand for?
Total parenteral nutrition
How do gallstones present?
Asymptomatic (incidental finding)
How do you treat gallstones?
Reassurance
What is a biliary colic?
Gallstone travels from gallbladder down thorugh the biliary tree towards the duodenum
How does a biliary colic present?
Gradual build-up of RUQ or epigastric pain which may radiate to the back +/- shoulder
May last 2-6 hours
Associated with nausea and vomiting
How do you investigate biliary colic?
Urinalysis CXR AXR LFTs Abdominal USS MRCP
How do you treat biliary colic?
Conservative
ERCP
What is acute cholecystitis?
Inflammation of the GB after a stone is stuck in the cystic duct
What are risk factors for acute cholecystitis?
Same as gallstones + rapid weight loss, “biliary sludge”
How does acute cholecystitis present?
Continous epigastric or RUQ pain
Vomiting, fever
Local peritoneum or a mass
Positive Murphy’s sign
What is Murphy’s sign?
Lay two fingers over the RUQ; ask patient to breathe in
Causes pain as inflamed gallbladder impinges on your finger
How do you investigate acute cholecystitis?
USS (best!) - CT, MRCP/ERCP
FBC; CRP, LFTs, U&Es
What are possible complications of acute cholecystitis?
Migrate to CBD and cause jaundice, cholangitis, acute pancreatitis
Gallstone ileus - cholecystoenteric fistula allows gallstones to pass into intestine
How do you treat acute cholecystitis?
Iv abx + iv fluids (nil by mouth)
US to confirm diagnosis
Cholecystectomy (laprascopically)
What is a cholangiocarcinoma?
Rare cancer of the gallbladder associated with Ulcerative colitis and Primary sclerosis Cholangitis
Cholangiocarinoma typically locally invades the?
Liver
What is the histopathological appearance of a cholangiocarcinoma?
Densely packed small glands in a fibrous stoma
How does cholangiocarcinoma present?
Obstructive jaundice, weight loss, anorexia, lethargy, 50% lymph node metastases, 20-30% peritoneal metastases at diagnosis
How do you investigate cholangiocarcinoma?
LFTs
CA 10-10 and CEA (tumour markers)
Prolonged INR
M/ERCP
How do you treat cholangiocarcinoma?
Surgery (resection)
Stents
