Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > Gallstones > Flashcards

Gallstones Flashcards

1
Q

Bile composition

A

water
bile acids/salts
bile pigments - biliverdin, bilirubin
cholesterol, fatty acids, phospholipids
electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between a bile acid and a bile salt?

A

bile salt = bile acid that has been conjugated with glycine or taurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bile function

A

emulsification of fats
absorption of fats and fat-soluble vitamins (ADEK)
neutralised gastric secretions
excretion of substances such as bile pigments and excess cholesterol
laxative and lubrication for chyme
bacteriocidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is chyme?

A

the pulpy acidic fluid which passes from the stomach to the small intestine, consisting of gastric juices and partly digested food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gallstones types

A

cholesterol stones
pigment stones
mixed stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes a gallstone?

A

super saturation of bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which type of gallstone is common in haemolytic anaemia?

A

pigment stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What increases the risk of cholesterol stones?

A

diet
obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who gets gallstones?

A

5Fs:
- fat
- female
- fertile
- forty
- family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where can gallstones cause blockages?

A

in the gallbladder = cholelithiasis
in the biliary system = choledocholithiasis
outside the biliary system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Complications of gallstones

A

biliary colic
cholecystitis
Mirizzi’s syndrome
obstructive jaundice
ascending cholangitis
acute obstructive suppurative ascending cholangitis
panreatitis
gallstone ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigation + management of gallstones

A

full history + examination
initial investigations:
- FBC, U&Es, LFTs, CRP, amylase/lipase
- erect chest XR/abdo XR
- USS

initial management:
- analgesia
- IV fluids
- antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gallstones symptoms

A

RUQ pain (after fatty food)
shoulder tip pain
nausea
fever
rigors
pale stools
dark urine
itching/pruritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Signs of gallstones

A

RUQ tenderness
Murphy’s sign
pyrexia
icteric/jaundiced
tachycardia
aerobilia
Charcot’s triad
Reynold’s pentad
Courvoisier’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Charcot’s triad

A

fever
RUQ pain
jaundice

(associated with cholangitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Reynold’s pentad

A

fever
abdo pain
jaundice
confusion
hypotension
(associated with obstructive ascending cholangitis)

17
Q

Courvoisier’s sign

A

jaundice + painless enlarged gallbladder

18
Q

What is biliary colic?

A

spasm of cystic ducts caused by calculi causing blockage

19
Q

Biliary colic presentation, investigation + management

A

RUQ pain

bloods - normal
USS - gallstones, thin-walled gallbladder

analgesia
consider elective cholecystectomy

20
Q

Define cholecystitis

A

when biliary colic progresses to inflammation/infection of the gallbladder

21
Q

Murphy’s sign

A

acute cholecystitis
ask patient to take and hold deep breath while palpating right subcostal area
if pain occurs when inflamed gallbladder comes into contact with examiner’s hand, Murphy’s sign is positive

22
Q

Cholecystitis presentation, investigation + management

A

RUQ pain
Murphy’s sign
fever

bloods - raised WBC/CRP, predominantly normal LFTs
USS - gallstones, thick-walled gallbladder

antibiotics
analgesia
consider ‘hot’ cholecystectomy
delayed cholecystectomy
cholecystostomy

23
Q

What is Mirizzi syndrome?

A

common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder

24
Q

Mirizzi syndrome presentation, investigation, management

A

RUQ pain
Murphy’s sign
fever
jaundice

bloods - raised WBC/CRP, obstructive LFTs
USS - gallstones, thick-walled gallbladder, dilated intrahepatic ducts
MRCP

antibiotics
analgesia
complex surgical management

25
Q

Obstructive jaundice presentation, investigations, management

A

jaundice
RUQ pain
Courvoisier’s Law = if gallbladder is palpable in jaundiced patient, it is unlikely due to gallstones

obstructive LFTs (high bilirubin, high ALP)
USS - dilated CBD +/- intrahepatic ducts
MRCP

management depends on cause
ERCP
cholecystectomy with common bile duct exploration

26
Q

What is ascending cholangitis?

A

ascending bacterial infection of biliary tree

biliary stasis in obstructive jaundice leads to infection in biliary tree

27
Q

Ascending cholangitis presentation, investigations, management

A

jaundice, RUQ pain, fever
Charcot’s triad

obstructive LFTs, raised WBC/CRP
USS - dilated common bile duct +/- intrahepatic ducts
MRCP

antibiotics
resuscitation
ERCP

28
Q

What is suppurative cholangitis?

A

pus in bile ducts

29
Q

Suppurative cholangitis presentation, investigations, management

A

jaundice
RUQ pain
fever
hypotension
mental obtundation
(Reynold’s pentad)

obstructive LFTs
raised WBC/CRP
USS - dilated common bile duct +/- intrahepatic ducts
MRCP

antibiotics
resuscitation
ERCP
?organ support
intensive care

30
Q

How can gallstones cause pancreatitis?

A

temporary blockage of pancreatic duct

31
Q

Pancreatitis presentation, investigation, management

A

epigastric pain

amylase >1000
USS - gallstones
CT abdomen/pelvis

supportive care
cholecystectomy

32
Q

What causes gallstone ileus?

A

occurs in chronic cholecystitis where a gallstone erodes forming cholecystoenteric fistula (commonly into duodenum)

33
Q

Gallstone ileus presentation, investigation, management

A

vomiting
constipation
hx of RUQ pain

may have normal bloods
XR/CT - aerobilia, bowel obstruction, may see gallstone at ICJ
CT abdomen/pelvis

NG tube
enterolithotomy

34
Q

How does a gallstone look on USS?

A

high attenuation of gallstone
acoustic shadow behind

35
Q

What is ERCP?

A

endoscopic retrograde cholangiopancreatography

36
Q

How does gallstone ileus look on abdominal xray?

A

small bowel obstruction
aerobilia in RUQ
circular radio-opaque object in RIF

37
Q

What is the most common cause of aerobilia?

A

previous ERCP with stricturotomy allowing air from GI tract to pass into biliary tree

38
Q

What is aerobilia?

A

presence of air in biliary system

Gastroenterology (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions