Hepatobiliary Disease

Question 1

What is acute cholecystitis?

Answer 1

Gallstone blocking CYSTIC DUCT OF NECK OF GALLBLADDER causing local inflammation (unlikely to be an infection).

Question 2

What type of pain is experienced with acute cholecystitis?

Answer 2

Prolonged severe epigastric/RUQ pain.

Question 3

What are some associated symptoms of acute cholecystitis?

Answer 3

Fever, guarding, positive Murphy’s sign.

Leucocytosis.

Question 4

What is biliary colic?

Answer 4

Gallstone blocking the BILE DUCT.

Question 5

What type of pain is experienced with biliary colic?

Answer 5

Intermittent (lasting <6hrs), intense dull epigastric pain associated with eating.
Radiates to back and shoulder blades.

Question 6

What are some associated symptoms of biliary colic?

Answer 6

N&V, sweating.

Question 7

What is acute ascending cholangitis?

Answer 7

Stones become impacted in BILIARY or HEPATIC ducts, leading to dilation of duct and hence bacterial infection.

Question 8

What bacteria most commonly causes acute ascending cholangitis?

Answer 8

E. Coli.

Question 9

What are some associated symptoms of acute ascending cholangitis?

Answer 9

CHARCOT’S TRIAD - fever, jaundice, RUQ pain.

Can also get confusion and hypotension (biliary sepsis).

Question 10

What is Charcot’s Triad and what condition is it associated with?

Answer 10

Fever, jaundice, RUQ pain.

Acute Ascending Cholangitis.

Question 11

What is primary sclerosing cholangitis?

Answer 11

A chronic inflammatory condition that leads to fibrosis and destruction of intra- and extra-hepatic bile ducts. Ultimately this leads to stricturing and cirrhosis.

Question 12

What are some associated symptoms of primary sclerosing cholangitis?

Answer 12

Pruritus, jaundice, fatigue, weight loss, RUQ pain.

Ulcerative colitis.

Question 13

What does ERCP show in primary sclerosing cholangitis?

Answer 13

Multiple biliary strictures giving a ‘beaded appearance’.

Question 14

What group of people are more likely to suffer from primary sclerosing cholangitis?

Answer 14

Those with ulcerative colitis.

Question 15

What is primary biliary cholangitis/cirrhosis?

Answer 15

Autoimmune destruction of the bile ducts, hence bile builds up in liver which leads to cirrhosis.

Question 16

In which population is primary biliary cholangitis/cirrhosis most commonly seen?

Answer 16

Middle-aged females.

Question 17

What are some associated symptoms of primary biliary cholangitis/cirrhosis?

Answer 17

Fatigue, pruritus.

Question 18

What does a positive Murphy’s sign support a diagnosis of?

Answer 18

Acute cholecystitis.

Question 19

What are some possible complications of acute cholecystitis?

Answer 19

Abscess, perforation, fistulae.

Question 20

What type of pain is experienced with acute ascending cholangitis?

Answer 20

Severe, continuous epigastric/RUQ pain.

Question 21

What are gallstones and what are they made of?

Answer 21

Formation of stones within the bile as a result of excess cholesterol. They are made of bile salts, phospholipids and cholesterol.

Question 22

What are the different compositions of gallstones?

Answer 22

Stones can be:

• Pure cholesterol (often large solitary, 10%).
• Pure pigment (10%).
• Mixed (often multiple stones, 80%).

Question 23

What imaging technique is used to investigate gallstones?

Answer 23

USS.

Question 24

What are some possible complications of gallstones?

Answer 24

Pancreatitis.
Choledocholithiasis (gallstones in CBD).
Biliary sepsis.

Question 25

What is choledocholithiasis?

Answer 25

Gallstones in the common bile duct.

Question 26

What is the management for gallstones?

Answer 26

Low fat diet.
Analgesia.
Antibiotics.
CHOLECYSTECTOMY for acute cholecystitis if done within 24hrs of onset. If not possible, wait for inflammation to decrease and repeat 6wks later electively.

Question 27

When should a cholecystectomy be performed?

Answer 27

For acute cholecystitis if done within 24hrs of onset. If not possible, wait for inflammation to decrease and repeat 6wks later electively.
Elective cholecystectomy can also be performed for biliary colic that is persistent.

Question 28

When should an emergency cholecystectomy be performed?

Answer 28

If a patient is septic.

Question 29

What are the risks of an emergency cholecystectomy?

Answer 29

Bleeding, infection, hernias, bile leaks.