Hepatobiliary - Gallstones, Biliary colic, Acute and Chronic Cholecystitis, Ascending Cholangitis Flashcards
Gallstones - what does bile contain?
Cholesterol
Bile pigments
Phospholipids
Gallstones - what are the two types of gallstones?
Cholesterol stones
Pigment stones
Can also get a mixture of the two so, Mixed stones
Gallstones - what are the risk factors for cholesterol stones?
Female
Forty
Fat
Fertile
Gallstones - what is biliary colic?
When a gallstone temporarily gets stuck and blocks the cystic duct, or common bile duct
Manifests at RUQ colicky pain that is worse postprandially
Subsides after a few hours once the stone has passed
Gallstones - what is the treatment for biliary colic?
Analgesia
Rehydrate
Nil by mouth
Cholecystectomy
Gallstones - what is acute cholecystitis?
Inflammation of the gallbladder, due to impaction of a stone in the wall of the neck of the gallbladder, and it is caused by a biliary colic
Gallstones - how does acute cholecystitis present?
RUQ pain - may radiate to right shoulder
Pain does not subside, unlike in biliary colic
Inflammatory component - Fever, high WCC
Gallstones - what is the classic sign of acute cholecystitis?
MURPHY’s SIGN
Pain and arrest on inspiration as inflamed gallbladder impinges on your fingers
Gallstones - Acute Cholecystitis, what investigations are done, and what do they show?
FBC - high WCC
US - thick walled GB, stones
AXR - may show porcelain GB
Gallstones - Acute Cholecystitis, what is the treatment?
Nil by mouth
Pain relief
IV Cefuroxime
Surgery - laparoscopic cholecystectomy
Gallstones - Chronic Cholecystitis, what is it?
Gallbladder is damaged by repeated bouts of acute inflammation
Gallstones - Chronic Cholecystitis, what are the clinical features?
‘Flatulent dyspepsia’ - abdo discomfort
distension
nausea
flatulence + fat intolerance
Gallstones - Chronic Cholecystitis, what are the investigations of choice?
Abdo US - to image stones
MRCP - to find stones
Gallstones - Chronic Cholecystitis, what is the management?
Cholecystectomy
Gallstones - cholecystitis, what happens if the stone moves to the ocmmon bile duct?
Obstructive jaundice and cholangitis
Gallstones - Acute Cholangitis, what is it?
Inflammation of the bile ducts (cholangitis), caused by bacterial infection
Bacteria ascends from duodenum
Can occur secondary to CBD stones or cholecystitis
Gallstones - Acute Cholangitis, what are the clinical features
CHARCOT’s TRIAD - 1. Fever
2. RUQ pain
3. (Cholestatic) Jaundice
Gallstones - Acute Cholangitis, what investigation is 1st line?
Abdo US - bile duct dilatation and bile duct stones
Gallstones - Acute Cholangitis, what is the gold standard investigation and treatment?
Endoscopic retrograde cholangiopancreatography (ERCP)
Allows VISUALISATION and REMOVAL of stones
Gallstones - Acute Cholangitis, what are the antibiotics given?
Cefuroxime
Metronidazole
Gallstones - what are some complications?
Gallstones in gallbladder and cystic duct - MUCOCOELE (mucous cyst)
Gallstones in bile ducts - Obstructive jaundice, cholangitis, pancreatitis
Gallstones in the gut - Gallstone ileus
Gallstones - what is gallstone ileus?
Small Bowel Obstruction secondary to an impacted gallstone
Table to describe Biliary Colic, Acute Cholecystitis, and Acute Cholangitis
Biliary Colic
