ICL Cholecystitis - Week 5 Flashcards
Biliary colic causes.
Obstruction in the cystic or common bile duct.
Symptoms of biliary colic
- Nausea
- Vomiting
- RUQ pain w radiation to R shoulder
2 x types of cholecystitis
- Calculous cholecystitis – caused by gallstones obstructing the cystic duct
- Acalculous cholecystitis – caused by dysfunction of gallbladder emptying
Cholecystitis
Inflammation of the gallbladder.
Symptoms of cholecystitis
- Severe & constant abdominal pain w radiation to R shoulder
- Mild jaundice
- Fever
- Tender gallbladder
Complications of cholecystitis
Gangrene, rupture, empyema, fistula.
Cholelithiasis symptoms
- Pain in RUQ w radiation to R scapula
- Nausea
- Vomiting
- Post-hepatic jaundice
- Pale stool
- Bloating & gas
- Dyspepsia
- Fatty or greasy food intolerance
- Post-prandial fullness
- Fever
- Abdominal tenderness (w +ve Murphy’s sign)
Cholelithiasis
presence of gallstones in the gallbladder (may be asymptomatic).
Choledocholithiasis
One of more gallstones in the common bile duct -> bile build-up.
Choledocholithiasis symptoms
- RUQ abdominal pain
- Dark urine
- Pale stools
- Jaundice.
Ascending cholangitis
Ascending bacterial infection & inflammation of the biliary tree, which disrupts the normal flow of bile.
Symptoms of ascending cholangitis.
- Fever
- Jaundice
- RUQ pain
Complications of ascending cholangitis
Sepsis.
External duct blockage
(i.e., Mirizzi’s syndrome) via large gallstone/multiple gallstones in Hartman’s pouch -> flopping of gall bladder onto common bile duct/common hepatic duct -> external compression.
Gallstone ileus
mechanical obstruction of GIT tract by gallstone after passing through the biliary-enteric fistula.
Investigations for gallbladder/liver/pancreatic pathologies.
- FBC – white cell elevation may indicate infection or inflammation
- CRP – protein produced by the liver which may indicate liver or biliary tract damage/inflammation
- Bilirubin – elevated due to high amounts of bile in the gallbladder
- LFTs
- U&E – to check renal function & rule out complications
- CT/MRI – to help show thickening of the gallbladder wall or increased density of fatty tissue around the gallbladder wall
- Ultrasound – to help show gallstones, thickening of the gallbladder wall, distended gallbladder
- MRCP (magnetic resonance cholangiopancreatography) – used if the Ab USS doesn’t detect any gallstones.
Additional tests to consider:
o Arterial blood gas (ABG) can be performed to check for sepsis.
o Coagulation panel (PT/INR) can be performed if sepsis suspected.
o Blood culture can also be performed to check for potential causative bacterial infection.
Risk factors for gallstones
- Oestrogen
- Female
- Age
- PMHx gallstones
- Rapid weight loss
- Fasting
- Obesity
