Liver, etc. 10 - Biliary Tract Disease Flashcards
What are the 2 categories of biliary tract disease?
GallstonesBile duct cancer
Do most gallstones cause symptoms?
No, most are asymptomatic (10-30% of local population have gallstones)
What problems can symptomatic gallstones cause? (6)
ColicCholecystitisCholangitisJaundicePancreatitisBowel obstruction (gallstone ileus)
What is biliary colic?
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
What are the risk factors for the development of gallstones? (10)
5 Fs:FemaleFat (obesity, high fat diet)Forty/ fiftyFertile (pregnancy)Fair (more common in caucasians)Also:Bile salt loss (Crohns)DiabetesDysmotility of GBProlonged fastingTPN
What type of gallstones are pure black?
Pigment
What is a 4th rare type of gallstones?
Primary bile duct stones (choledocholithiasis)
What are the features of biliary colic?
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
Does acute cholecystitis cause gallbladder distension?Does chronic cholecystitis cause gallbladder distension?
Acute = distendedChronic = not distended
When does gallstone pain tend to come on?
After eating a big fatty meal
How are gallstones diagnosed?
USCT scanMRCP/ ERCPHIDAEUS
What is a HIDA scan?
stands for hepatobiliary iminodiacetic acid scan, creates pictures of your liver, gallbladder, biliary tract and small intestine
What is the treatment of biliary colic? (5)
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
Treatment of acute cholecystitis? (5)
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)
What complications of gallstones occur when the stone migrate into the CBD? (3)
JaundiceCholangitisAcute pancreatitis
What is the difference between biliary colic and cholecystitis?
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)
What is cholangitis?
Inflammation of the bile duct system that is usually related to a bacterial infection - usually caused by a bloackage
What symptoms suggest a common bile duct pathology? (5)
ItchNauseaAnorexiaJaundiceAbnormal LFTs
What does ERCP stand for?
Endoscopic retrograde cholangio pancreatography
What is ERCP used for?
Diagnosis and treatment of pancreatic and bile duct problems e.g. gallstone removal
How can stones within the CBD be removed?
ERCPLaparoscopicallyOpen surgery
How is acute pancreatitis due to gallstones treated?
CholecystectomyERCP/ ES if frail
What is gallstone ileus?How does it form?
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)
What is colic?
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.
How is gallstone ileus treated?
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)
What type of patients does gallstone ileus normally occur in?
Elderly women
How do patients with cholangiocarcinoma usually present? (6)
JaundiceWeight lossAnorexiaLethargy50% = lymph node metastases20-30% = peritoneal metastases
Staging/ assessment of cholangiocarcinoma?
Duplex USCT/ ERCP/ PTCMRI/ MRCP/ MRA
what is PTC?
Precutaneous transhepatic cholangiography - 1dye delineates the biliary tract on the x-ray images and reveals any significant abnormalities
What is MRA?
Magnetic resonance angiography
What is the only chance of cure of cholangiocarcinoma?
Surgical resection (nile duct and liver resection)
what palliative treatment can be given for cholangiocarcinoma/
Biliary stent (ERCP/ PTC insertion)
