HPB Flashcards
What is Bile formed from?
Cholesterol, Phospholipids and Bile pigments
Where is bile stored?
Gallbladder
Why do Gallstones form?
Due to a supersaturation of bile
What are the different types of gallstone?
Cholesterol Stones
Pigment Stones
Mixed Stones
How are Cholesterol stones formed?
Formed from excess cholesterol, linked to poor diet and obesity
How are Pigment stones formed?
Formed from bile pigments due to an excess pigment production
What are Mixed gallstones formed of?
A mixture of Cholesterol and Bile pigments
What are some risk factors for Gallstone disease?
The 5 Fs Pregnancy Oral contraceptives Haemolytic anaemia Malabsorption conditions
What are the 5 Fs in relation to gallstones?
Fat Female Fertile Fourty Family Hx
What is Biliary colic?
Condition when the gallbladder neck becomes impacted with a gallstone. There are no features of inflammation, however can have pain due to contraction of the neck against the stone
How is the pain often described in biliary colic?
Sudden
Dull
Colicky
Where is the pain felt in biliary colic?
RUQ
Can radiate to Epigastrium +/- Back
What can often trigger biliary colic?
Consumption of fatty foods
What are the management options for biliary colic?
Analgesia - Paracetamol +/- NSAIDs. Opioids if needed
Lifestyle modifications
Surgery
When should a Laparoscopic Cholecystectomy be offered with biliary colic?
Within 6/52 of initial presentation, due to risk of recurrence/complications
What is Acute Cholecystitis?
Inflammation of the gallbladder due to stone impaction
How does Acute Cholecystitis present?
Constant RUQ pain
Signs of inflammation - Lethargy, fever
Murphy’s +ve
What are some other possible differentials with Acute Cholecystitis?
GORD
Peptic Ulcer disease
Acute pancreatitis
IBD
What abnormalities may be present in bloods with Acute Cholecystitis?
Raised CRP
Raised ALP
Which imaging is first-line with suspected Acute Cholecystitis?
USS
What does USS demonstrate in acute cholecystitis?
Presence of gallstones/sludge
Increased gallbladder wall thickness
Bile duct dilatation
When should an MRCP be performed with suspected Acute Cholecystitis?
If USS is inconclusive
What are the management steps for acute cholecystitis?
IV Abx - Co-Amoxiclav +/- Metronidazole
Analgesia and Antiemetics
Laparoscopic Cholecystectomy within 1 week
Percutaneous drainage if unsuitable for Lap Chole
What is Mirizzi Syndrome?
A stone in the cystic duct compresses the common hepatic duct giving obstructive jaundice
What can gallbladder inflammation lead to?
Formation of a cholecystoduodenal fistula allowing gallstones to pass directly to small bowel
What is Bouveret’s Syndrome?
Stone impaction in proximal duodenum causing a gastric outlet obstruction
What is Gallstone ileus?
Stone impaction at the terminal ileus giving small bowel obstruction
What is Cholangitis?
Infection of the biliary tree due to a combination of biliary outflow obstruction and biliary infection
Why does biliary obstruction lead to Cholangitis?
Stasis of fluid combined with elevated intraluminal pressure allows for bacterial colonisation of the biliary tree to become pathological
What are some common causes of cholangitis?
Gallstones ERCP Cholangiocarcinoma Pancreatitis Primary Sclerosing Cholangitis
What are the common causative organisms of Cholangitis?
E. Coli
Klebsiella
Enterococcus
What are some clinical features of Cholangitis?
RUQ Pain Fever Jaundice Pyrexia Rigors Hypotension
What is Charcots Triad in relation to Cholangitis?
Pain
Fever
Jaundice
What is Reynolds Pentad in relation to Cholangitis?
Jaundice Fever RUQ Pain Hypotension Confusion
What may bloods demonstrate in Cholangitis?
Raised ALP, Gamma GT and Bilirubin
What is the gold-standard imaging for suspected Cholangitis?
ERCP
What is the appropriate management of Cholangitis?
IV Abx
Systemic Support/Sepsis management
How can Cholangitis be treated?
ERCP +/- Sphincterotomy/Stenting
