Liver and Gallbladder

Question 1

What are the three components of bile?

Answer 1

1. Cholesterol
2. Bile pigments - broken down from Hb
3. Phospholipids

Question 2

What are the risk factors for developing gallstones?

Answer 2

Smoking
Pregnancy 
Obesity 
Old age
Sedentary lifestyle
High fat diet

Question 3

What are the 5 Fs of gallstones?

Answer 3

Female
Fertile
Fat
Fair
Forty

Question 4

In terms of location of pain, character of pain, duration, presence of mass, fever and leukocytosis - how does biliary colic present?

Answer 4

Character: Visceral
Location: Epigastric
Duration: <3 hours
No mass
No fever 
No leukocytosis

Question 5

In terms of location of pain, character of pain, duration, presence of mass, fever and leukocytosis - how does acute cholecystitis present?

Answer 5

Character: Parietal
Location: RUQ
Duration: <3 hours
Mass in RUQ
Fever
Leukocytosis

Question 6

Biliary colic is precipitated by spasm of a dilated cystic duct that is obstructed by gallstones. What are the symptoms of biliary colic?

Answer 6

Sweating 
Vomiting
Sudden onset abdominal pain, radiates to shoulder and back 
Abdominal tenderness 
Pain at night

Question 7

Acute cholecystitis is caused by cystic duct obstruction by gallstones. What are the signs of acute cholecystitis?

Answer 7

Palpable mass in RUQ
Murphy’s sign = put two fingers on RUQ and ask to breathe in. Causes pain and arrest of inspiration as the inflamed gallbladder impinges on fingers
Abdominal guarding
Jaundice

Question 8

What investigations can you do if you suspect gallstones?

Answer 8

USS of gallbladder
Endoscopic retrograde cholangiopancreatography
FBC - leukocytosis (high WCC)
Bilirubin - hyperbilirubinaemia occurs due to obstruction
Amylase - increased due to obstruction of pancreatic duct

Question 9

How would you treat gallstones?

Answer 9

Analgesia
IV fluids
Nil by mouth
Antibiotics
Laparoscopic cholecystectomy - within 24 hours for biliary colic and 7 days for acute cholecystitis

Question 10

Cholangitis is a bile duct infection which presents with Charcot’s triad. What composes this triad?

Answer 10

RUQ pain
Jaundice
Rigors

Question 11

How would you treat cholangitis?

Answer 11

Piperacillin

Question 12

What are the complications of gallstones in the gallbladder and cystic duct?

Answer 12

Biliary colic
Acute and chronic cholecystitis 
Mucocele 
Empyema 
Carcinoma 
Mirizzi's syndrome

Question 13

What are the complications of gallstones in the bile duct?

Answer 13

Obstructive jaundice
Cholangitis
Pancreatitis

Question 14

What are the complications of gallstones in the gut?

Answer 14

Gallstone ileus