Gallstones, Cholecystitis and Cholagiocarcinoma Flashcards
How do gallstones form?
- Due to imbalance between the proportions of cholesterol and bile salts, excess component comes out as gallstones
What are the 3 types of gallstones?
- Cholesterol stones => large + yellow
- Bilirubinate stones => small + pigmented
- Mixed stones => Ca salts + bile pigments + cholesterol
What is cholecystitis?
Inflammation of the gall bladder
What is Cholangiocarcinoma?
Cancer of the bile duct
What are the risk factors of gallstone formation?
- Crohn’s syndrome (malabsorption of bile salts)
- Gender (female)
- Obesity
- Middle age
- Family History
- Haemolytic anaemias (increase in bilirubin production)
What is the differential diagnosis of Acute cholecystitis?
- Acute pancreatitis
- Acute appendicitis
- Acute cholangitis
- Peptic ulcers
- Pneumonia
- GORD
- Acute Coronary Syndrome
What is the clinical presentation of gallstones
- Depend on what the gallstone is obstructing, may be asymptomatic
Gallstone obstruction in cystic duct = Biliary Colic or Cholecystitis
Gallstone obstruction in common bile duct = Jaundice or Ascending Cholangitis
Gallstone obstruction at Ampulla Vater = Acute Pancreatitis
What is biliary colic?
- Sudden pain in right upper quadrant, colicky in nature
What causes biliary colic?
Gall bladder contracting against acute obstructed duct
What are the symptoms of biliary colic?
- Colicky pain
- Pain radiating to back and tip of scapula
- Nausea and vomiting
What causes Acute Cholecystitis?
- Complete blockage of the cystic duct for a prolonged period of time
What is the clinical presentation of Acute Cholecystitis?
- Fever
- Right Upper Quadrant pain radiating to right shoulder
- Murphy’s sign (arresting of inspiration when pressing down on RUQ)
- Deranged LFTs
What are the investigations in suspected Acute Cholecystitis?
=> Ultrasound
If ultrasound remains unclear then cholescintigrphy is performed
What is the management of Acute Cholecystitis?
- IV antibiotics
- Early laproscopic cholecystectomy within 1 week
What is the management of Biliary Colic?
Laproscopic cholecystectomy reduces complications
What is the name given for cholecystitis not caused by gallstones?
Acute Acalculous Cholecystitis
What is Ascending Cholangitis and what is it characterised by?
- Inflammation and infection of the common bile duct, caused by E. Coli secondary to gallstone blockage
=> Characterised by Charcots Triad:
- Jaundice
- Fever
- RUQ pain
What is cholangiocarcinoma?
- Cancer of the bile duct
What is the main clinical presentation of cholangiocarcinoma?
Jaundice
What is the main investigations in suspected cholangiocarcinoma?
=> Ultrasound 1st
MRCP or CT/MRI once more certain its Cholangiocarcinoma
What is the management of cholangiocarcinoma?
Surgical resection
