Gallstones and obstructive jaundice Flashcards
Causes of gallstones
Derangement of biliary chemistry Female Elderly Fertile Family history Obesity
Presentation of gallstones
Many are asymptomatic Biliary colic Biliary dyspepsia Acute cholecystitis CBD stone/jaundice Acute pancreatitis Gallstone ileus
What would biliary colic present as?
Severe pain in RUQ/epigastrium Lasting mins-hours May radiate to back or chest Often N&V Usually settles spontaneously Recurrence may be associated with fat intake Minimal systemic upset
Acute cholecystitis
Possible history of biliary colic
More persistent pain
RUQ tenderness with positive Murphy’s sign
May have systemic pointers - inc temp, WBC, CRP
More unwell and likely to be admitted
Management of biliary colic
Analgesia Low fat diet Lose weight Elective surgery if troubled Possible stone dissolution
Acute cholecystitis management and investigation
IV fluids Antibiotics Analgesia Urgent investigation Surgery if fit and CBD clear
Investigation - LFTs, amylase, USS, MRCP, general fitness
Why do CBD stones matter and what is management of them?
More likely to cause complications
More difficult to remove
ERCP for most or operation
Surgery - almost always laparoscopic (keyhole), open if surgery difficult or to deal with complications - conversion
Open if much previous surgery or with dual pathology
Complications of gallbladder surgery
Complications - bile duct injury, bile leak, damage to other structures
Other complications - persistent pain, diarrhoea, dyspepsia, , post-cholecystectomy syndrome
Management of obstructive jaundice
Blood tests including liver screen
Imaging USS, usually followed by CT and/or MRCP
ERCP +/- stent or stone removal
Endoscopic US +/- biopsy
Charcot’s triad
RUQ pain and tenderness
Obstructive jaundice
Fever +/- rigors
Med emergency IV fluids and antibiotics Close monitoring on HDU Biliary decompression once well enough Most commonly related to CBD stones
Biliary malignancy locations and risk factors
Bile duct, GB, ampulla, pancreas
RFs - primary sclerosing cholangitis, CBD stones, liver fluke reaction, cirrhosis, hepatitis
RFs for pancreatic cancer
Age, smoking, obesity, diabetes, pancreatitis, gallstones/GB surgery , alcohol
CT, EUS, biopsy - tests
manage with surgery if possible, biliary stent, bypass surgery
Poor prognosis
