Hepatobiliary disease Flashcards
What is cholelithiasis
Solid deposits of cholesterol, bilirubin, or calcium salts that form in the gallbladder.
What are the types of gallstones?
Cholesterol stones (most common, yellow, linked to obesity and diet).
Pigment stones (black or brown, linked to hemolysis or liver disease).
What are the risk factors for gallstones? (4 F’s)
Fat, Female, Forty, Fertile
(progesterone make gall bladder lazy so pregnant women hv higher risk, TPN also hv high risk as no food in system, gall bladder stasis>form stone)
What are the diagnostic criteria for biliary pain?
Pain in epigastrium and/or right upper quadrant and all of the following:
1. builds up to a steady level and lasting 30 mins or longer
2. Occurring at different intervals (not daily)
3. Severe enough to interrupt daily activities or lead to ED visit
4. Not significantly (<20%) related to bowel movements
5. Not significantly (<20% relieved by postural change or acid suppression)
Supportive criteria:
1. N/V
2. Radiation to back or right infrasubscapular region
3. Waking from sleep
How are gallstones diagnosed?
Ultrasound Hepatobiliary system (best initial test).
What is the treatment for symptomatic gallstones?
Cholecystectomy
What is acute cholecystitis?
Inflammation of the gallbladder due to cystic duct obstruction by a gallstone.
What are the symptoms of acute cholecystitis?
Severe RUQ pain (persistent, not just post-meal)
Fever, nausea, vomiting
Positive Murphy’s sign (pain on deep palpation of RUQ)
How is acute cholecystitis diagnosed?
- Local signs of inflammation -
Murphy, RUQ pain - Systemic signs of inflammation - Fever, elevated CRP, elevated WBC
- Ultrasound (first-line test) → gallbladder wall thickening, stones
HIDA scan (if ultrasound is inconclusive)
What is the Charcot’s triad in cholangitis?
Pain, fever, jaundice
What is the treatment for acute cholecystitis?
NPO, IV fluids, IV antibiotics
Cholecystectomy (definitive treatment)
What is choledocholithiasis?
Gallstones in the common bile duct (CBD), causing obstruction
What are the symptoms of choledocholithiasis?
Intermittent RUQ pain
Jaundice (due to bile duct obstruction)
Elevated bilirubin & ALP (cholestatic pattern)
How is choledocholithiasis diagnosed?
Ultrasound (may show dilated CBD)
MRCP (gold standard, non-invasive)
What is the treatment for choledocholithiasis?
ERCP (Endoscopic Retrograde Cholangiopancreatography) for stone removal
What is acute cholangitis?
A life-threatening infection of the biliary tree due to obstruction
what is Reynolds’ Pentad in severe cholangitis?
Charcot’s Triad + Hypotension + Altered mental status → Sepsis!
How is acute cholangitis diagnosed?
- systemic inflammation - chills and rigor or lab data
- Cholestasis - jaundice, LFT >1.5x of standard)
- Imaging - biliary dilatation, evidence of etiology on imaging (stricture, stone etc)
What is the treatment for cholangitis?
IV antibiotics (e.g., piperacillin/tazobactam) with supportive care
ERCP for drainage (urgent in severe cases)
