Gallstones- emergency complications

Question 1

what is mirizzine syndrome?

Answer 1

gall bladder gets infected over time and sticks to common bile/hepatic duct which can lead to fistulas

Question 2

what is a gallstone ileus?

Answer 2

gall stone leaves gall bladder and obstructs the terminal ileum.

Question 3

6 Ix for biliary disease

Answer 3

US
MRCP
CT Abdo with contrast
endoscopic US
ERCP
PTC- percutaneous transhepatic cholangiography

Question 4

what can US show us about the biliary system

Answer 4

thickness of wall

ducts- if dilated

Question 5

what can MRCP show us in the biliary system?

Answer 5

biliary anatomy

clear view of common bile duct

Question 6

what can endoscopic US show us?

Answer 6

microlithiasis

Question 7

what can you do with endoscopic US?

Answer 7

FNA biopsy

drainage of pancreatic abscess

Question 8

3 complications of ERCP

Answer 8

pancreatitis
perforation
bleeding

Question 9

2 things we can do with PTC

Answer 9

place stents, take brushings

Question 10

3 reasons you get gallstones in pregnancy

Answer 10

• oestrogen increases cholesterol secretion into bile
• progesterone decreases bile acid secretion and slows gall bladder emptying
• weight changes precipitate symptommatic gallstones

Question 11

2 complications of gallstones in pregnancy

Answer 11

induce miscarriage

preterm labour

Question 12

what is cholelithiasis

Answer 12

asymptommatic gall stones

Question 13

mx of cholelithiasis

Answer 13

watch and wait

Question 14

what is biliary colic

Answer 14

gall stones that are symptommatic

Question 15

3 symptoms and signs of biliary colic

Answer 15

severe RUQ pain, lasts 2-6h, N bloods

Question 16

mx of biliary colic

Answer 16

elective cholecystectomy

Question 17

what is cholecystitis

Answer 17

inflammation of gallbladder

Question 18

4 symptoms and signs of cholecystitis

Answer 18

continuous RUQ pain lasting >12h, fever, increased inflam markers

Question 19

mx of cholecystitis

Answer 19

abx, cholecystectomy

Question 20

what is a mucocele

Answer 20

gall bladder blockage

Question 21

3 symptoms and signs of mucocele

Answer 21

recurrent biliary colic, continuous RUQ pain, N bloods

Question 22

what is empyema

Answer 22

collection of pus in gall bladder

Question 23

symptoms and signs of empyema

Answer 23

same as cholecystitis, not responding to abx, swinging fever

Question 24

2 mx of empyema

Answer 24

cholecystectomy, cholecystostomy

Question 25

what is choledocolithiasis

Answer 25

stone in common bile duct

Question 26

4 symptoms and signs of choledocolithiasis

Answer 26

severe epigastric pain, worse with eating, associated with vomiting, abnormal LFTs

Question 27

Mx of choledocolithiasis

Answer 27

MRCP then urgent ERCP

Question 28

what is cholangitis

Answer 28

infection of bile ducts

Question 29

3 symptoms and signs of cholangitis

Answer 29

septic, abn LFTs and inflam markers

Question 30

mx of cholangitis

Answer 30

urgent ERCP