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GI - Y2 > L18 - Biliary disease / Gall stones > Flashcards

L18 - Biliary disease / Gall stones Flashcards

1
Q

Biliary colic

A

Increase in gall bladder wall tension which produces a characteristic type of pain.

Blockage of outflow of bile during gallbladder contraction.

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2
Q

Cystic duct obstruction for a few hours may lead to…

A

Acute gall bladder inflammation: acute cholecystitis

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3
Q

Choledocholithiasis

A

Presence of one or more gallstones in the common bile duct.

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4
Q

Gall stone in ampulla of Vater might cause

A

Abdominal pain, jaundice
Stagnant bile above obstructing bile duct can become infected.
- bacteria can spread rapidly back up the ductal system to liver
- produces life threatening ascending cholangitis

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5
Q

Obstruction of pancreatic duct results in

A

Activation of pancreatic digestive enzymes within pancreas - leads to acute pancreatitis

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6
Q

Chronic cholecystitis

A

Progressive fibrosis and loss of function of gallbladder.

Pre-disposes to gall bladder cancer

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7
Q

Cholesterol gall stones

A

Liver cells secrete cholesterol and lecithin phospholipids into bile.

Cholesterol supersaturation of bile appears to be a pre-requisite for gall stone formation.

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8
Q

How does cholesterol come into solution

A

Cholesterol (usually insoluble) comes into solution by forming vesicles with phospholipid (lecithin)

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9
Q

Gall stone formation

A

Nucleation: transition of cholesterol from soluble state to crystalline form.

Mucin hypersecretion by gall bladder mucosa creates a visoelastic gel that fosters nucleation.

Gall bladder hypomobility and bile stasis promotes growth and formation of gall stones

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10
Q

Acute calculous cholecystasis

A
  • inflammation of gall bladder, develops in setting of obstructed cystic or bile duct
  • nausea / vomitting
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11
Q

Mirizzi syndrome

A

Impacted stone in cystic duct causes extrinsic compression which obstructs the common hepatic duct.

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12
Q

Acute acalculous cholecystitis

A

Inflammed gall bladder in absence of obstructed cystic or bile duct

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13
Q

Cholangitis

A

Infection in biliary system

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14
Q

Charcot triad (cholangitis)

A
  1. Fever
  2. Right upper quadrant pain
  3. Jaundice
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15
Q

Organisms causing cholangitis

A 
E.coli 
Streptococcus Faecalis 
Clostridium 
Enterbacter
Psuedomonas
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16
Q

Recurrent pyogenic cholangitis

A
  • Initiated by parasitic infestation of the biliary ducts by opisthorchis sinensis
  • Bile stasis, secondary bacterial infection, pigment stones form around
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17
Q

Primary sclerising cholangitis

A
  • non-suppurative inflammation and fibrosis of the biliary duct system
  • fatigue, pruiritus and jaundice
  • progressive destruction of bile duct, leading to cirrhosis and liver failure
18
Q

Primary biliary cholangitis

A
  • primary cholestatic biliary disease that presents with fatigue and itching
  • fatigue, itching, asymptomatic elevation of alkaline phosphatase.
  • Jaundice: progressive destruction of bile ductules that eventually lead to liver cirrhosis and hepatic failure
19
Q

What might be seen on physical examination of a patient with biliary disease?

A

Vital signs
- tachycardia, hypotension suggests hypovolemia, presence of sepsis

Yellow discolouration of skin 
- indirect hyperbilirubinaemia 
Orange hue 
- hepatocellular jaundice 
Dark green tint 
- prolonged biliary obstruction
20
Q

Xanthoma

A

Irregular yellow patch or nodule on skin, caused by deposition of lipid.

21
Q

Hyperbilirubinaemia may have what effect on the eyes

A

Scleral icterus

Yellow discolouration of white of eyes.

22
Q

Describe formation of bilirubin

A
  • break down product of haem
  • unconjugated bilirubin hydrophobic and transported in blood reversibly to albumin
  • taken up by hepatocyte
  • converted to conjugated bilirubin by glutamyl transferase
  • actively secreted into the biliary canaliculi
23
Q

Where is alanine aminotransferase found

A

In cardiac and skeletal muscle, renal and cerebral nerve cells.

Increase in ALT suggests liver injury

24
Q

Iatrogenic injury

A

Tissue / organ damage caused by necessary medical treatment

25
Q

Summarise liver function tests

A 
Bilirubin 
Aminotransferases 
- leaks on damage to hepatocytes
Alkaline phosphatase 
- also present in bone 
Gamma glutamyl transferase
26
Q

Conjugated bilirubin in bile is converted to…

A

Bilirubin —-bacterial proteases—- urobilogen

Urobilogen (white)——–stercobilinogen (brown) (excreted)

27
Q

Where is stercobilinogen excreted from?

A

Kidneys

28
Q

Pre-hepatic Jaundice

A

Increased rate of haemolysis (breakdown of RBCs).

Results to an increase in amount of unconjugated bilirubin present in blood, deposition of this can lead to a jaundiced appearance.

29
Q

When is the only time that bilirubin found in urine?

A

Post-hepatic jaundice.

30
Q

Investigations of Jaundice

A

Blood
Secretions (urine)
Radiology
Endoscopy

31
Q

Compare primary sclerosing cholangitis and primary biliary cirrhosis

A

PSC

  • inflammation
  • affecting intra and extra hepatic ducts

PBC
- chronic cholestasis
- affecting intrahepatic ducts
-

32
Q

Compare secondary sclerosing cholangitis and secondary biliary cholangitis

A

SSC

  • chronic obstruction form a defined pathology
  • affects intra and extra hepatic ducts
  • rare

SBC

  • chronic obstruction
  • extra hepatic ducts
  • main bile duct obstruction
33
Q

Cholangiocarcinoma

A 
Adenocarcinoma of the bile duct. 
Location:
- peripheral 
- hilar (most common)
- distal
34
Q

Cholecystolithiasis

A

Inflamed gall bladder.

Symptoms

  • biliary colic
  • cholecystitis
  • mucocoel
  • empyema
  • perforation
  • cancer
35
Q

Empyema

A

Cavity filled with pus

36
Q

Choledocolithiasis

A

Stone in bile duct.

  • acute pancreatitis
  • cholangitis
  • Mirizzi syndrome
  • gall stone ileus
37
Q

Mirizzi syndrome

A

Gall stone becomes impacted in the cystic duct or neck of the gall bladder, causing compression of the common hepatic duct.

38
Q

Types of Mirizzi syndrome

A

Type 1: stone stuck in fundus of gall bladder, causes compression of cystic bile duct

Type 2: Cholecystodochal fistula

Type 3 & 4: Increasing size of defect

39
Q

Gall stone ileus

A

Rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine.

40
Q

Calcot’s triangle

A 
Orientated so that its apex is directed at liver.
Includes 
- common hepatic duct 
- cystic duct 
- inferior surface of the liver

GI - Y2 (18 decks)

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