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GIHEP > L11 + 12: Gallstones, Pancreatitis & Jaundice > Flashcards

L11 + 12: Gallstones, Pancreatitis & Jaundice Flashcards

1
Q

What is the function of the gall bladder?

A

storage + concentration of bile (not vital)

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2
Q

Which 2 components of bile aid in digesting fats?

A
  1. Bile Salts

2. Phospholipids

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3
Q

List 4 components of the bile which are excreted?

A
  1. Bilirubin
  2. Cholesterol
  3. Calcium Salts
  4. Copper
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4
Q

What is cholelithiasis? (definition)

A

gallstones in the gall bladder

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5
Q

What is choledocholithiasis? (definition)

A

gallstones in the CBD

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6
Q

Gallstones are predominantly composed of what?

A

Cholesterol

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7
Q

List some of the risk factors/predisposing factors for developing gallstones

A
  • female
  • increasing age
  • obesity
  • diet: high fat/low fibre; high lipids
  • T2DM
  • high dose oestrogen (pregnancy, OCP, HRT)
  • fertility
  • medications (clofibrate)
  • gall bladder hypomotility/stasis
  • haemolytic disorders
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8
Q

What illness can clofibrate cause? (hint: biliary-related)

A

gallstones

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9
Q

What can cause gallbladder hypomotility/stasis?

A
  • rapid weight loss (bariatric surgery)

- fasting

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10
Q

Bilirubin (pigment) gallstones are less common but they may occur. List some of the possible causes of these gallstones

A
  • bile salt depletion (Crohn’s ileitis, ileal surgery)
  • cirrhosis
  • haemolysis
  • parasites
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11
Q

Briefly describe the pathogenesis of gallstones

A
  • altered bile composition - lithogenic bile (increased cholesterol)
  • gall bladder hypomotility leading to bile stasis
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12
Q

List some of the symptoms of symptomatic gall stones

A
  • biliary colic
  • steady RUQ/epigastric pain
  • pain >30 mins and < 4 hours
  • pain may occur post-prandial (after eating due to CCK release)
  • may radiate to right shoulder/back
  • crescendo pattern
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13
Q

List 4 complications of gallstones

A
  1. Acute Cholecystitis
  2. Common Bile Duct Obstruction
  3. Mirizzi Syndrome
  4. Gall Bladder Adenocarcinoma
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14
Q

What is Mirizzi Syndrome?

A

extrinsic compression of the CBD by a gallstone impacted in the cystic duct/gall bladder

    • stone in Hartman’s pouch
    • causes obstructive jaundice
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15
Q

What is a porcelain gallbladder suggestive of?

A

Gall Bladder Adenocarcinoma

- the gall bladder becomes calcified and usually has long-standing gallstones

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16
Q

What is cholecystitis? (definition)

A

inflammation of the gall bladder

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17
Q

Acute cholecystitis may be a complication of gall stones if there is a…..

A

cystic duct obstruction

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18
Q

List the symptoms of acute cholecystitis

A
  • fever*
  • nausea
  • vomiting
  • pain in RUQ (for days)
  • RUQ tenderness*
  • positive Murphy’s sign*
  • high WCC*
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19
Q

What is the treatment/management plan for acute cholecystitis?

A
  • analgesia
  • abdominal US
  • ± IV empiric antibiotics
  • IV fluids
  • Nil Po if vomiting
  • Laparoscopic Cholescystectomy*
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20
Q

What are the main differences in symptoms in cholelithiasis (gallstones) and acute cholecystitis (inflammation of gall bladder)?

A

in Acute Cholecystitis will have….

  • fever
  • RUQ tenderness
  • high WCC
  • positive Murphy’s sign
21
Q

List some of the complicationso of acute cholecystitis

A
  • necrotising inflammation + risk of perforation
  • empyema (pus in gall bladder)
  • mucocoele
  • fistula formation + risk of gallstone ileus
  • adhesions
22
Q

A complication of acute cholecystitis is fistulas. What structures would the fistula form between and what is a possible consequence?

A
  • fistula b/w gall bladder and stomach/duodenum

- gallstone ileus may occur (gall stone gets stuck in terminal ileum)

23
Q

List 3 consequences of a CBD obstruction by gall stones

A
  1. Obstructive Jaundice
  2. Ascending Cholangitis
  3. Acute Pancreatitis
24
Q

What is chronic cholecystitis and what is it a/w?

A
  • always a/w gall stones

- gall bladder shows chronic response to repeated obstruction/inflammation

25
Q

Describe the appearance of chronic cholecystitis

A
  • fibrotic, shrunken gall bladder w/ stones
  • thickened muscle
  • atrophied mucosa
  • diverticula
26
Q

What are the possible treatments for gall stones?

A

Symptomatic - remove (cholecystectomy)

Asymptomatic - observe

27
Q

What is an MRCP?

A
  • non-invasive

- MRI scan of the liver, gallbladder, bile ducts, pancreas and pancreatic duct

28
Q

How would an extrahepatic bile duct obstruction appear on ultrasound?

A

there will be dilated ducts above the obstruction

29
Q

If there are gallstones causing an extrahepatic bile duct obstruction, what would be the treatment?

A

ERCP w/ sphincterotomy ± stone removal

30
Q

If there is a stricture causing an extrahepatic bile duct obstruction, what would be the treatment?

A

stent

31
Q

If there is a tumour causing an extrahepatic bile duct obstruction, what would be the treatment?

A

stent

32
Q

What is ascending cholangitis a complication of?

A

blockage of a bile duct (esp. CBD)

33
Q

What is Charcot’s Triad?

A

a/w biliary obstruction and ascending cholangitis

  1. High Fever
  2. Pain
  3. Jaundice
34
Q

What is Reynold’s Pentad?

A

a/w biliary obstruction and ascending cholangitis

  1. High Fever
  2. Pain
  3. Jaundice
  4. Hypotension
  5. Altered Mental State
35
Q

What is the treatment/management plan for ascending cholangitis?

A
  • IV antibiotics
  • IV fluids
  • urgent decompression of bile duct (removal of bile and the underlying cause of the blockage)
36
Q

What is the most common cause of a hepatic abscess?

A

biliary tract disease a/w ascending infection

37
Q

Is mild or severe pancreatitis more common?

A

Mild Pancreatitis

38
Q

Why may there be hypocalcaemia with acute pancreatitis?

A
  • fat that gets damaged attracts calcium - these create calcium soaps (saponification)
  • fat necrosis occurs
39
Q

What is the treatment for acute pancreatitis caused by gall stones?

A
  • urgent ERCP and sphincterotomy

- laparoscopic cholecystectomy when it resolves (if needed)

40
Q

What is a positive murphy’s sign suggestive of?

A

Acute Cholecystitis

41
Q

What are the histological features of chronic pancreatitis?

A
  • patchy, irreversible fibrosis*
  • ongoing inflammation
  • exocrine > endocrine pancreas
  • strictures
  • dilatation + cysts behind strictures*
42
Q

List some causes of chronic pancreatitis

A
  • chronic alcohol use
  • childhood causes (e.g CF)
  • — CF more typically a/w pancreatic insufficiency
  • idiopathic
43
Q

List some of the symptoms of chronic pancreatitis

A
  • pain (dull, epigastric, radiating to back)
  • weight loss
  • steatorrhoea (fat in the stool)
  • malabsorption (b/c there is a deficiency of fat-soluble vitamins, ADEK)
44
Q

List the treatments for chronic pancreatitis

A
  • analgesia

- enzyme supplements

45
Q

What is a pancreatic pseudocyst and what are some of the causes?

A
  • collection of pancreatic fluid in disrupted tissue
  • not a true cyst

Causes:

  • acute/chronic pancreatitis
  • pancreatic surgery
  • trauma
46
Q

What is another term for surgical jaundice?

A

obstructive jaundice

47
Q

What is the most common cause of obstructive jaundice (surgical jaundice)?

A

GALL STONES (an extrahepatic bile duct obstruction)

48
Q

List some indications for laparoscopic cholecystectomy

A
  • symptomatic cholelithiasis (stones in gallbladder)
  • cholecystitis
  • porcelain gallbladder

GIHEP (24 decks)

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