W7 Biliary Tract Disease (Biliary Colic, Cholecystitis, Cholangiocarcinoma) Flashcards
List some risk factors of gallstones.
- age <40
- female
- high fat diet
- obesity
- hyperlipidaemia
- pregnancy
- bile salt loss e.g. Crohn’s
- Diabetes
- Dysmotility of gallbladder
- Prolonged fasting
- Total Parenteral Nutrition
What two compounds can cause gallstones when in excess?
- bilirubin
- cholesterol
What are three causes of gallstones? (i.e. three physical occurrences that cause gallstones as opposed to risk factors)
- infection
- bile stasis
- abnormal bile composition
What is biliary colic?
When a stone gets stuck in the cystic duct
How does biliary colic present clinically? (pain, pain radiation, what is it associated with)
- acute onset of RUQ abdo pain (can also be epigastric)
- gets worse over few hours
- radiates to back/shoulder
- associated with indigestion/nausea
What 5 imaging mechanisms are used to diagnose gallstones?
- ultrasound
- CT
- MRCP/ERCP
- HIDA scan
- EUS
What is EUS?
Endoscopic Ultrasound Scan
What is MRCP?
Magentic Resonance Cholangiopancreatography
What is ERCP?
Endoscopic Retrograde Cholangiopancreatography
What is HIDA?
Hepatobiliary iminodiacetic acid
What is treatment for recurrent episodes of biliary colic?
- consider for surgery
- cholecystectomy
What is treatment for biliary colic if unfit for surgery?
Ursodeoxycholic acid 10mg/kg/day
What is acute cholecystitis?
Inflammation of the gallbladder due to obstruction of cystic duct
What occurs in acute cholecystitis if left untreated?
- infection
- gallbladder necrosis
What is treatment of acute cholecystitis?
- IV antibiotics
- IV fluids
- nil by mouth
- urgent cholecystectomy
What is standard practice to confirm diagnosis of acute cholecystitis?
Ultrasound
What are symptoms of acute cholecystitis?
- acute RUQ abdo pain (and can be epigastric)
- pain radiating to right shoulder/back
- nausea/vomiting
- fever
What are the 4 main types of gallstones?
- cholesterol
- pigment
- mixed (most common)
- primary bile duct stones
What are the two major complications of gallstones?
- stone migration into CBD
- gallstone ileus
What can occur if stone migrates into CBD? (3 things)
- cholangitis
- acute pancreatitis
- jaundice
What are some symptoms of common bile duct blockage?
- jaundice
- nausea
- itching
- anorexia
What diagnostic test can be used to determine CBD pathology?
LFTs
What causes itching in blockage of common bile duct?
High level of bilirubin in blood that enters bloodstream after being backed up by blockage
What are two common causes of acute pancreatitis?
- alcohol
- gallstones
How does gallstone enter the GI tract in gallstone ileus?
Through a fistula between the duodenum and gallbladder (formed as a result of inflammation and necrosis)
What kind of pain does gallstone ileus cause?
Intermittent colic
What is treatment for gallstone ileus? (urgent and 3 months later?)
- urgent laparotomy to remove stone
- 3 months later cholecystectomy
What is cholangiocarcinoma?
Cancer of the bile ducts
What are 4 symptoms of colangiocarcinoma?
- jaundice
- lethargy
- weight loss
- anorexia
What are 2 common metastases of cholangiocarcinoma?
- lymph nodes metastases
- peritoneal metastases
What are some imaging tests done to stage cholangiocarcinoma?
- duplex ultrasound
- CT
- ERCP
- PTC
- MRI/MRCP
What is a PTC test used for?
contrast medium injected into bile duct and then patient is x-rayed to check for blockage in bile duct
What is the only curative treatment in cholangiocarcinoma?
bile duct and liver resection
What is the palliative treatment in cholangiocarcinoma?
biliary stent
