Hepatobiliary - Gallstones, Biliary colic, Acute and Chronic Cholecystitis, Ascending Cholangitis

Question 1

Gallstones - what does bile contain?

Answer 1

Cholesterol

Bile pigments

Phospholipids

Question 2

Gallstones - what are the two types of gallstones?

Answer 2

Cholesterol stones

Pigment stones

Can also get a mixture of the two so, Mixed stones

Question 3

Gallstones - what are the risk factors for cholesterol stones?

Answer 3

Female

Forty

Fat

Fertile

Question 4

Gallstones - what is biliary colic?

Answer 4

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

Question 5

Gallstones - what is the treatment for biliary colic?

Answer 5

Analgesia

Rehydrate

Nil by mouth

Cholecystectomy

Question 6

Gallstones - what is acute cholecystitis?

Answer 6

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

Question 7

Gallstones - how does acute cholecystitis present?

Answer 7

RUQ pain - may radiate to right shoulder

Pain does not subside, unlike in biliary colic

Inflammatory component - Fever, high WCC

Question 8

Gallstones - what is the classic sign of acute cholecystitis?

Answer 8

MURPHY’s SIGN

Pain and arrest on inspiration as inflamed gallbladder impinges on your fingers

Question 9

Gallstones - Acute Cholecystitis, what investigations are done, and what do they show?

Answer 9

FBC - high WCC

US - thick walled GB, stones

AXR - may show porcelain GB

Question 10

Gallstones - Acute Cholecystitis, what is the treatment?

Answer 10

Nil by mouth

Pain relief

IV Cefuroxime

Surgery - laparoscopic cholecystectomy

Question 11

Gallstones - Chronic Cholecystitis, what is it?

Answer 11

Gallbladder is damaged by repeated bouts of acute inflammation

Question 12

Gallstones - Chronic Cholecystitis, what are the clinical features?

Answer 12

‘Flatulent dyspepsia’ - abdo discomfort
distension
nausea
flatulence + fat intolerance

Question 13

Gallstones - Chronic Cholecystitis, what are the investigations of choice?

Answer 13

Abdo US - to image stones

MRCP - to find stones

Question 14

Gallstones - Chronic Cholecystitis, what is the management?

Answer 14

Cholecystectomy

Question 15

Gallstones - cholecystitis, what happens if the stone moves to the ocmmon bile duct?

Answer 15

Obstructive jaundice and cholangitis

Question 16

Gallstones - Acute Cholangitis, what is it?

Answer 16

Inflammation of the bile ducts (cholangitis), caused by bacterial infection

Bacteria ascends from duodenum

Can occur secondary to CBD stones or cholecystitis

Question 17

Gallstones - Acute Cholangitis, what are the clinical features

Answer 17

CHARCOT’s TRIAD - 1. Fever

                               2. RUQ pain
                               3. (Cholestatic) Jaundice

Question 18

Gallstones - Acute Cholangitis, what investigation is 1st line?

Answer 18

Abdo US - bile duct dilatation and bile duct stones

Question 19

Gallstones - Acute Cholangitis, what is the gold standard investigation and treatment?

Answer 19

Endoscopic retrograde cholangiopancreatography (ERCP)

Allows VISUALISATION and REMOVAL of stones

Question 20

Gallstones - Acute Cholangitis, what are the antibiotics given?

Answer 20

Cefuroxime

Metronidazole

Question 21

Gallstones - what are some complications?

Answer 21

Gallstones in gallbladder and cystic duct - MUCOCOELE (mucous cyst)

Gallstones in bile ducts - Obstructive jaundice, cholangitis, pancreatitis

Gallstones in the gut - Gallstone ileus

Question 22

Gallstones - what is gallstone ileus?

Answer 22

Small Bowel Obstruction secondary to an impacted gallstone

Question 23

Table to describe Biliary Colic, Acute Cholecystitis, and Acute Cholangitis

Answer 23

Biliary Colic