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YEAR 2: CSI > Gallstones > Flashcards

Gallstones Flashcards

1
Q

What are the commonest causes of acute abdominal pain?

A 
· nonspecific abdominal pain
· cholelithiasis 
· renal colic
· biliary colic
· Cholecystitis
· Appendicitis
· Diverticulitis
· Infection
· Renal stones
· Pancreatitis
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2
Q

What investigations can be carried out to make a diagnosis?

A

· Blood pressure
· Pregnancy test (to exclude possibility of ectopic pregnancy)
· FBC
· Serum electrolytes + CRP
· Creatinine + urine + general kidney function test
· ECG + serum troponin (to exclude MI)
· Abdominal X-ray
· US
· CT (not first line since most stones are radiolucent- don’t show up)
· Hepatobiliary iminodiacetic acid (HIDA) scan (cholescintigraphy -> using a radioactive tracer)

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3
Q

What could sudden onset of pain be caused by?

A
  • perforated ulcer
  • oesophageal tear or rupture
  • nephrolithiasis
  • biliary colic
  • acute cholecystitis
  • pancreatitis
  • appendicitis
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4
Q

What could intermittent pain be caused by?

A

Bowel obstruction

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5
Q

What could persistent pain be caused by?

A

Diverticulitis

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6
Q

What actions exacerbate pain caused by cholecystitis or cholelithiasis?

A

Eating, especially eating fatty food.

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7
Q

Pain caused by what condition is exacerbated by movement?

A

Apendicitis

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8
Q

Pain relieved by eating that worsens after a few hours is caused by?

A

duodenal ulcer

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9
Q

What is biliary colic?

A

Temporary obstruction of the cystic duct/ CBD which causes colicky pain.

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10
Q

What are the symptoms?

A
  • colicky pain

- vomiting

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11
Q

Describe what you would see in the bloods of a person with biliary colic?

A
  • Normal WBC
  • Normal CRP
    THERE IS NO INFLAMMATION
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12
Q

What is cholecystitis?

A

Inflammation that is usually caused by gallstones.
Very rarely, it can be caused by poor perfusion of the gallbladder (acalulous cholecystitis by this only occurs in acutely unwell patients)

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13
Q

What sign alludes to cholecystitis?

A

Murphy’s sign (pain on inspiration in RIGHT UPPER QUADRANT)

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14
Q

Describe what you would see in the bloods of a person with cholecystitis?

A

Elevated WBC
High CRP
Fever
THERE IS INFLAMMATION

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15
Q

What is cholangitis?

A

Inflammation of the biliary tree which leads to infection. THIS IS THE MOST SEVERE.

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16
Q

What is the main symptom of cholangitis?

A

Jaundice

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17
Q

Describe what you would see in the bloods of a person with cholangitis?

A
  • elevated WBC
  • High CRP
  • Elevated liver secretions (e.g. increased albumin, ALP)
  • fever
18
Q

How are cholesterol gallstones formed?

A

1) Super saturation of cholesterol in bile -> it crystalises (nucleation factors involved) -> creates stones in the gall bladder.
2) Gallbladder hypomotility -> Incomplete/impaired gallbladder emptying

19
Q

What are the risk factors for gallstones?

A
  • age (>40)
  • gender (females are more susceptible)
  • obesity (+ Diabetes Mellitus)
  • hypercholesterolaemia
  • Hb disorders
  • fertility
20
Q

What are some complications of gallstones?

A
  • Mirizzi syndrome
  • Acute pancreatitis
  • Biliary obstruction
  • Gallstone ileus
  • Jaundice
  • Buvert’s syndrome
21
Q

What is Mirizzi syndrome?

A

obstruction of cystic duct by gallstones

22
Q

What is gallstone ileus?

A

Gallstone perforates through the wall of the gallbladder and hedges itself into the ileum.

23
Q

What is Buvert’s syndrome?

A

Stone obstructs the top of the duodenum.

24
Q

If person with gallstones has symptoms, what is the treatment?

A

Laparoscopic cholecystectomy -> removal of gall bladder

25
Q

What are some complications of surgery?

A

GENERAL

  • infection
  • damage to nearby organs
  • anaesthesia risks
  • DVT clots - muscle inactivity due to procedure
  • scars from surgery
  • Bleeding
  • Post cholecystectomy syndrome

SPECIFIC

  • Haemorrhage
  • Bile duct injury
26
Q

How do you inform patients about procedures?

A
  1. Find out the extent of their knowledge of their condition/ procedure.
  2. Explain diagnosis and procedure
  3. Give them all the treatment options (medical + non-medical)
  4. Tell them the purpose of the procedure
  5. Tell them the risks associated with the procedure
  6. Tell them about follow up treatment
27
Q

What should you check before asking them for consent?

A

Their capacity

28
Q

What factors modulate formation of cholesterol microcrystals in supersaturated bile?

A

kinetic protein factors like mucin

29
Q

If pigment salts are brown, that suggests…?

A

infections of the biliary tract

30
Q

If pigment salts are black, that suggests…?

A

calcium bilirubinate -> haemolytic anaemia, ineffective haematopoiesis, CF

31
Q

What are the symptoms of acute cholecystitis?

A
  • Prolonged abdominal pain
  • associated fever
  • Leukocytosis
32
Q

What are the drug treatments are being looked into treating these conditions?

A
  • Somatostatin analogues (to block release of CCK and therefore bile)
  • Fibrates (to block rate-limiting enzyme 7-alpha-hydroxylase and cause increased cholesterol and decreased bile acid production)
  • Bile acid sequestrants (to prevent reabsorption of bile acids in the ileum and lead to lower cholesterol levels as the body is forced to use it as a substrate to produce new bile acids)
33
Q

Once gallstones form, is the risk of developing symptomatic gallstone disease higher or lower in those with efficient bladder emptying?

A

HIGHER: efficient gall bladder emptying makes it more likely for the stone to end up in the biliary tree + cause symptomatic disease.

34
Q

What is a combination of RUQ pain, jaundice and fever in cholangitis is known as?

A

Charot’s triad

35
Q

Describe the mechanism of cholecystitis.

A
  1. Stone stuck in cystic duct.
  2. Blocks bile from leaving the bladder.
  3. This leads to inflammation of the mucosa
  4. Phospholipase A secretion
  5. Prostaglandins are released
36
Q

Pain caused by what is usually constant?

A

inflammation

37
Q

Pain caused by what is usually colicky?

A

obstruction in bowel or ureter

38
Q

Is visceral pain well localised?

A

NO- dull and achey + spreads

39
Q

Is parietal pain well localised?

A

YES- sharp

40
Q

What does pain arising from the kidneys feel like?

A

It radiates from flanks to loin

41
Q

What does pain arising from appendicitis feel like?

A

starts centrally and gradually radiates to RIF (right iliac fossa)

YEAR 2: CSI (8 decks)

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