Gallstone disease: biliary colic, acute cholecystitis and acute cholangitis Flashcards
What are the risk factors for gallstone disease? 5 F’s
Female
Fat
Forty
Fertile
FH
Look at the anatomy of the gallbladder and biliary tree
What is biliary colic?
Formation of gallstones in the gallbladder which can lodge into the cystic duct, typically after meals which causes pain.
What is acute cholecystitis?
Gallstone remains long enough in cystic duct to cause inflammation.
What is ascending cholangitis?
Obstruction of the CBD which can lead to infection of the biliary tree.
What are the clinical features of biliary colic, acute cholecystitis and ascending cholangitis?
Biliary colic:
-RUQ/epigastric colicky pian
–> Triggered by meals
–> May radiate to shoulder
Acute cholecystitis:
-RUQ/epigastric pain + fever
-Murphy’s sign +ve: palpate RUQ, halt in inspiration due to pain.
Acute cholangitis:
-RUQ/epigastric pain + fever + jaundice
-Hypotensive + confusion
What investigations would you carry out?
Bloods: FBC, UEs, LFTs, CRP
USS of the liver
How do you differentiate between the 3?
Bloods:
-Biliary colic: likely to be normal i.e. no derangement of LFTs or raised CRP.
-Cholecystitis: CRP may be raised in cholecystitis and may be mild derangement of LFTs
-Cholangitis: CRP raised, derangement of LFTs. USS may show bile duct dilatation.
*Rise in bilirubin is likely to be greater in cholangitis compared to cholecystitis
*Rise in ALP > Rise in ALT + AST with LFTs.
What is the treatment for biliary colic?
Pain relief
-Mild-moderate pain: NSAIDs + PPI
-Severe: IM diclofenac
Elective laparoscopic cholecystectomy
What is the treatment for acute cholecystitis?
IV abx + Laprascopic cholecystectomy within 1 week
What is the treatment for ascending cholangitis?
Fluid resuscitation
IV abx
ERCP (24-48 hours) - Endoscopic retrograde cholangiopancreatography
