Liver, etc. 10 - Biliary Tract Disease

Question 1

What are the 2 categories of biliary tract disease?

Answer 1

GallstonesBile duct cancer

Question 2

Do most gallstones cause symptoms?

Answer 2

No, most are asymptomatic (10-30% of local population have gallstones)

Question 3

What problems can symptomatic gallstones cause? (6)

Answer 3

ColicCholecystitisCholangitisJaundicePancreatitisBowel obstruction (gallstone ileus)

Question 4

What is biliary colic?

Answer 4

term used to describe a type of pain related to the gallbladder that occurs when a gallstone transiently obstructs the cystic duct and the gallbladder contracts

Question 5

What are the risk factors for the development of gallstones? (10)

Answer 5

5 Fs:FemaleFat (obesity, high fat diet)Forty/ fiftyFertile (pregnancy)Fair (more common in caucasians)Also:Bile salt loss (Crohns)DiabetesDysmotility of GBProlonged fastingTPN

Question 6

What type of gallstones are pure black?

Answer 6

Pigment

Question 7

What is a 4th rare type of gallstones?

Answer 7

Primary bile duct stones (choledocholithiasis)

Question 8

What are the features of biliary colic?

Answer 8

Gradual build up pain in RUQ (when it eases it leaves a bruised/ aching feeling for a few days - can also cause epigastric pain)Radiates to back/ shoulderAssociated with indigestion/ nausea

Question 9

Does acute cholecystitis cause gallbladder distension?Does chronic cholecystitis cause gallbladder distension?

Answer 9

Acute = distendedChronic = not distended

Question 10

When does gallstone pain tend to come on?

Answer 10

After eating a big fatty meal

Question 11

How are gallstones diagnosed?

Answer 11

USCT scanMRCP/ ERCPHIDAEUS

Question 12

What is a HIDA scan?

Answer 12

stands for hepatobiliary iminodiacetic acid scan, creates pictures of your liver, gallbladder, biliary tract and small intestine

Question 13

What is the treatment of biliary colic? (5)

Answer 13

Pain killersLow fat diet/ lose weight if obeseObserve in 3-6 monthsIf the patient is getting recurrent episodes of pain consider elective cholecystectomyIf patient unfit, try to dissolve gallstones with ursodeoxycholic acid

Question 14

Treatment of acute cholecystitis? (5)

Answer 14

IV antibiotics and IV fluidsNil by mouthUS to confirm diagnosisUrgent cholecystectomy (asap) ORInternal cholecystectomy depending on how inflamed the gall bladder s (antibiotics and come back in 3 months)

Question 15

What complications of gallstones occur when the stone migrate into the CBD? (3)

Answer 15

JaundiceCholangitisAcute pancreatitis

Question 16

What is the difference between biliary colic and cholecystitis?

Answer 16

When the stone(s) passes into the cystic duct it causes pain and is called biliary colicIf this occurs for a prolonged period of time, it causes gallbladder inflammation (cholecystitis)

Question 17

What is cholangitis?

Answer 17

Inflammation of the bile duct system that is usually related to a bacterial infection - usually caused by a bloackage

Question 18

What symptoms suggest a common bile duct pathology? (5)

Answer 18

ItchNauseaAnorexiaJaundiceAbnormal LFTs

Question 19

What does ERCP stand for?

Answer 19

Endoscopic retrograde cholangio pancreatography

Question 20

What is ERCP used for?

Answer 20

Diagnosis and treatment of pancreatic and bile duct problems e.g. gallstone removal

Question 21

How can stones within the CBD be removed?

Answer 21

ERCPLaparoscopicallyOpen surgery

Question 22

How is acute pancreatitis due to gallstones treated?

Answer 22

CholecystectomyERCP/ ES if frail

Question 23

What is gallstone ileus?How does it form?

Answer 23

Small bowel obstruction due to gallstone impacted in distal ileum Fistula forms between the gallbladder and duodenum allowing a large gallstone to pass into the small intestine causing obstruction (moves down the SB causing intermittent colic, present with distal SB obstruction)

Question 24

What is colic?

Answer 24

form of pain that starts and stops abruptly. It occurs due to muscular contractions of a hollow tube (colon, ureter, gall bladder, etc.) in an attempt to relieve an obstruction by forcing content out.

Question 25

How is gallstone ileus treated?

Answer 25

Urgent laparotomySB enterotomy to remove stoneInterval cholecystectomy in 3 months (if the patient is old and frail the stone is removed and there is not usually a cholecystectomy)

Question 26

What type of patients does gallstone ileus normally occur in?

Answer 26

Elderly women

Question 27

How do patients with cholangiocarcinoma usually present? (6)

Answer 27

JaundiceWeight lossAnorexiaLethargy50% = lymph node metastases20-30% = peritoneal metastases

Question 28

Staging/ assessment of cholangiocarcinoma?

Answer 28

Duplex USCT/ ERCP/ PTCMRI/ MRCP/ MRA

Question 29

what is PTC?

Answer 29

Precutaneous transhepatic cholangiography - 1dye delineates the biliary tract on the x-ray images and reveals any significant abnormalities

Question 30

What is MRA?

Answer 30

Magnetic resonance angiography

Question 31

What is the only chance of cure of cholangiocarcinoma?

Answer 31

Surgical resection (nile duct and liver resection)

Question 32

what palliative treatment can be given for cholangiocarcinoma/

Answer 32

Biliary stent (ERCP/ PTC insertion)