Gallbladder stuff

Question 1

What is Cholelithiasis?

Answer 1

gallstones

Question 2

What is a gallstone?

Answer 2

Hard stone/gravel-like material within the biliary system

Question 3

Cholelithiasis can cause…?

Answer 3

Colic
Cholcystitis
Jaundice
Pancreatic & bowel obstruction

Question 4

Gallstones are more common in?

Answer 4

Women
Older age (both sexes)

Question 5

What are the different categories of gallstones?

Answer 5

MixedCholesterol
Pigmented
Primary diet stone

Question 6

Cholesterol gallstones are caused by?

Answer 6

Excess cholesterol

Question 7

Pigmented gallstones are caused by?

Answer 7

Excess bilirubin

Question 8

What are the risk factors for gallstones

Answer 8

Faorty
Female 
Fatty diet
Fat
Fertile (pregnancy 
\+ hyperlipidaemia, bile salt loss (Crohn's), diabetes, dysmotility of gallbladder, prolonged fasting, TPN

Question 9

What does TPN stand for?

Answer 9

Total parenteral nutrition

Question 10

How do gallstones present?

Answer 10

Asymptomatic (incidental finding)

Question 11

How do you treat gallstones?

Answer 11

Reassurance

Question 12

What is a biliary colic?

Answer 12

Gallstone travels from gallbladder down thorugh the biliary tree towards the duodenum

Question 13

How does a biliary colic present?

Answer 13

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

Question 14

How do you investigate biliary colic?

Answer 14

Urinalysis
CXR
AXR
LFTs
Abdominal USS
MRCP

Question 15

How do you treat biliary colic?

Answer 15

Conservative

ERCP

Question 16

What is acute cholecystitis?

Answer 16

Inflammation of the GB after a stone is stuck in the cystic duct

Question 17

What are risk factors for acute cholecystitis?

Answer 17

Same as gallstones + rapid weight loss, “biliary sludge”

Question 18

How does acute cholecystitis present?

Answer 18

Continous epigastric or RUQ pain
Vomiting, fever
Local peritoneum or a mass
Positive Murphy’s sign

Question 19

What is Murphy’s sign?

Answer 19

Lay two fingers over the RUQ; ask patient to breathe in

Causes pain as inflamed gallbladder impinges on your finger

Question 20

How do you investigate acute cholecystitis?

Answer 20

USS (best!) - CT, MRCP/ERCP

FBC; CRP, LFTs, U&Es

Question 21

What are possible complications of acute cholecystitis?

Answer 21

Migrate to CBD and cause jaundice, cholangitis, acute pancreatitis
Gallstone ileus - cholecystoenteric fistula allows gallstones to pass into intestine

Question 22

How do you treat acute cholecystitis?

Answer 22

Iv abx + iv fluids (nil by mouth)
US to confirm diagnosis
Cholecystectomy (laprascopically)

Question 23

What is a cholangiocarcinoma?

Answer 23

Rare cancer of the gallbladder associated with Ulcerative colitis and Primary sclerosis Cholangitis

Question 24

Cholangiocarinoma typically locally invades the?

Answer 24

Liver

Question 25

What is the histopathological appearance of a cholangiocarcinoma?

Answer 25

Densely packed small glands in a fibrous stoma

Question 26

How does cholangiocarcinoma present?

Answer 26

Obstructive jaundice, weight loss, anorexia, lethargy, 50% lymph node metastases, 20-30% peritoneal metastases at diagnosis

Question 27

How do you investigate cholangiocarcinoma?

Answer 27

LFTs
CA 10-10 and CEA (tumour markers)
Prolonged INR
M/ERCP

Question 28

How do you treat cholangiocarcinoma?

Answer 28

Surgery (resection)

Stents