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Y3R5: Medicine I 🩺 > L10: Biliary Disorders > Flashcards

L10: Biliary Disorders Flashcards

1
Q

Anatomy of Gall Bladder

A
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2
Q

Capacity of Gall Bladder

A

30-50 ml

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3
Q

Types of Gall Bladder Stones

A
  • Cholesterol stones
  • Pigment stones (20%)
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4
Q

Cholesterol Stones

A
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5
Q

Pigment Gall Bladder Stones

A
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6
Q

Characters of Biliary Pain in Gall Bladder Stones

A
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7
Q

Gall Bladder Stones

Physical Examination

A
  • Tenderness to deep palpation (No rebound).
  • Murphy sign (inspiratory arrest during deep palpation of the RUQ).
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8
Q

Investigations for Gall Bladder Stones

A
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9
Q

ECG in Gall Bladder Stones

A

to exclude myocardial ischemia (Pain may be due to myocardial ischemia).

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10
Q

Lab tests in Gall Bladder Stones

A
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11
Q

US in Gall Bladder Stones

A
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12
Q

Radionuclide scanning (HIDA) in Gall Bladder Stones

A
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13
Q

CT Scan in Gall Bladder Stones

A
  • Less sensitive than US to detect gallstones.
  • Only 20% radiopaque.
  • Most useful to exclude other causes of upper abdominal pain such as aortic aneurysm, perihepatic abscess, or pancreatic pseudocyst.
  • Detects rare complications such as air in GB wall in emphysematous cholecystitis or air-filled GB in biliary-enteric fistula.
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14
Q

Plain Radiograph in Gall Bladder Stones

A

Most useful for diagnosis of intestinal obstruction.

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15
Q

DDx of Gall Bladder Stones

A

Causes of upper abdominal pain
- e.g. MI, Acute cholecystitis, cholangitis, Acute pancreatitis, Intestinal obstruction,
PUD, RLL pneumonia,

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16
Q

Managment of Gall Bladder Stones

A
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17
Q

Admission Criteria of Gall Bladder Stones

A
18
Q

Discharge Crireria of Gall Bladder Stones

A
19
Q

Complications of Gall Bladder Stones

A
20
Q

Etiology of Cholecystitis

A
  • Acute calculous cholecystitis
  • Acalculous cholecystitis (10%)
21
Q

Managment of Cholecystitis

A

Admission Criteria

  • All cases of cholecystitis should be admitted for
    parenteral antibiotics, analgesia, fluid replacement,
    and cholecystectomy in 24 - 72 hr.
  • Unstable patients (gallbladder perforation or
    sepsis) require immediate surgery
22
Q

Def of Cholangitis

A

Partial or complete CBD obstruction:
- Gallstones, tumor, cyst, or Stricture.

23
Q

Symptoms of Cholangitis

A
24
Q

Managment of Cholangitis

A

Admission Criteria

  • All patients should be admitted for IV antibiotic and possible biliary drainage
  • Admit patients with signs of septic shock
    to the ICU.
25
Q

Epidemology of GB Cancer

A
  • Rare malignancy
  • Usually affecting elderly patients.
  • Associated with gall-stones (in 70–90% of cases), calcified (“porcelain”) gallbladder and gallbladder polyps > 1 cm in diameter
26
Q

Prophylactic cholecystectomy should particularly be considered for …..

A

calcified (“porcelain”) gallbladder and gallbladder polyps > 1 cm in diameter

27
Q

Clinical Features of GB Cancer

A

 RUQ discomfort, weight loss, and jaundice.
 A hard, tender mass is sometimes felt in GB region.
 Occasionally condition is asymptomatic.

28
Q

Investigations for GB Cancer

A
29
Q

Managment of GB Cancer

A

 Surgical resection rarely curative as cancer spreads early to surrounding structures, including liver.

 No clear role for systemic chemotherapy or radiotherapy.

 Palliative approaches include biliary stenting to relieve jaundice,

30
Q

Mean survival Rate of GB Cancer

A

Mean survival rate is six months, and the five-year survival rate < 5%.

31
Q

def of Gallstone Ileus

A

Mechanical intestinal obstruction due to gallstone impaction within bowel lumen.

32
Q

Size of Stone in Gallstone Ileus

A

Stone is usually >2.5 cm.

33
Q

Epidemeology of Gallstone Ileus

A

 Most cases occur in patients >65 years.

 Female > Male 5:1

34
Q

Pathogenesis of Gallstone Ileus

A

 Cholecystenteric fistula develops, permitting stone passage into intestine.

 Duodenum is most common site of fistula formation.

 Terminal ileum is most common site of impaction.

35
Q

Rigler Triad

Gallstone Ileus

A
36
Q

Etiology of GB Empyema

A
  • The presence of pus within the gallbladder.
  • It usually develops following acute cholecystitis,
    or cystic duct obstruction due to tumor e.g.,
    cholangiocarcinoma.
37
Q

Symptoms of GB Empyema

A

Usually presents with RUQ pain and sepsis.

38
Q

Complications of GB Empyema

A

GB perforation with subsequent peritonitis is an
important complication if left untreated.

39
Q

Dx of GB Empyema

A

CT or U/S may show a distended, fluid-filled GB,
with pericholecystic fluid.

40
Q

TTT of GB Empyema

A
  • IV antibiotics (e.g., 3rd generation cephalosporin
    & metronidazole).
  • Percutaneous GB drain insertion.
  • Cholecystectomy is usually delayed because of high rate of post-operative septic complications
41
Q

Done

A

Y3R5: Medicine I 🩺 (47 decks)

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