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
