Gallstones pt 3

Question 1

Define primary sclerosing cholangitis with risk factors and common gender affected

Answer 1

Chronic progressive inflammation of bile ducts (intra and extrahepatic) of unknown etiology, resulting in strictures, cholestasis, cirrhosis and liver failure.

Biggest risk factor is ulcerative colitis and common in males

Question 2

Symptoms? PSC

Answer 2

First asymptomatic. Then signs of cholestasis (jaundice, pale stool, dark urine, pruritis)
If acute cholangitis (fever, RUQ pain, jaundice)

then cirrhosis and liver failure (hepatosplenomegaly, ascites)

Question 3

Diagnosis and treatment of PSC

Answer 3

High GGT, ALP, conjugated bilirubin.
AST ALT mildly elevated or normal
Serology: high pANCA

ERCP shows bead on string appearance of bile ducts

Balloon dilation and stent placement in bile ducts for symptomatic relief. Definitive treatment depends on location of strictures. Intrahepatic needs liver transplant. Extrahepatic needs hepatoenteric anastomosis with removal of extrahepatic ducts and placement of t tube for bile drainage

Question 4

Define gallstone ileus

Answer 4

Gallstone causing small bowel obstruction esp in ileocecal valve due to fistula formation (cholecystoenteric fistula)

Question 5

Symptoms of gallstone ileus

Answer 5

First with acute cholecystitis (RUQ pain, N,V, fever) then small bowel obstruction (abdomen distention and pain, N,V)

Question 6

Diagnosis and treatment of gallstone ileus

Answer 6

Abdomen X-ray / CT showing dilated small bowel loops, gallstone, and pneumobilia (air in the bile ducts)

Treated with enterolithotomy (open to laparoscopic) to remove stone. Then consider cholecystectomy and fistula repair