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GI > W7 Biliary Tract Disease (Biliary Colic, Cholecystitis, Cholangiocarcinoma) > Flashcards

W7 Biliary Tract Disease (Biliary Colic, Cholecystitis, Cholangiocarcinoma) Flashcards

1
Q

List some risk factors of gallstones.

A
  • 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
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2
Q

What two compounds can cause gallstones when in excess?

A
  • bilirubin

- cholesterol

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3
Q

What are three causes of gallstones? (i.e. three physical occurrences that cause gallstones as opposed to risk factors)

A
  • infection
  • bile stasis
  • abnormal bile composition
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4
Q

What is biliary colic?

A

When a stone gets stuck in the cystic duct

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5
Q

How does biliary colic present clinically? (pain, pain radiation, what is it associated with)

A
  • acute onset of RUQ abdo pain (can also be epigastric)
  • gets worse over few hours
  • radiates to back/shoulder
  • associated with indigestion/nausea
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6
Q

What 5 imaging mechanisms are used to diagnose gallstones?

A
  • ultrasound
  • CT
  • MRCP/ERCP
  • HIDA scan
  • EUS
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7
Q

What is EUS?

A

Endoscopic Ultrasound Scan

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8
Q

What is MRCP?

A

Magentic Resonance Cholangiopancreatography

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9
Q

What is ERCP?

A

Endoscopic Retrograde Cholangiopancreatography

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10
Q

What is HIDA?

A

Hepatobiliary iminodiacetic acid

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11
Q

What is treatment for recurrent episodes of biliary colic?

A
  • consider for surgery

- cholecystectomy

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12
Q

What is treatment for biliary colic if unfit for surgery?

A

Ursodeoxycholic acid 10mg/kg/day

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13
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder due to obstruction of cystic duct

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14
Q

What occurs in acute cholecystitis if left untreated?

A
  • infection

- gallbladder necrosis

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15
Q

What is treatment of acute cholecystitis?

A
  • IV antibiotics
  • IV fluids
  • nil by mouth
  • urgent cholecystectomy
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16
Q

What is standard practice to confirm diagnosis of acute cholecystitis?

A

Ultrasound

17
Q

What are symptoms of acute cholecystitis?

A
  • acute RUQ abdo pain (and can be epigastric)
  • pain radiating to right shoulder/back
  • nausea/vomiting
  • fever
18
Q

What are the 4 main types of gallstones?

A
  • cholesterol
  • pigment
  • mixed (most common)
  • primary bile duct stones
19
Q

What are the two major complications of gallstones?

A
  • stone migration into CBD

- gallstone ileus

20
Q

What can occur if stone migrates into CBD? (3 things)

A
  • cholangitis
  • acute pancreatitis
  • jaundice
21
Q

What are some symptoms of common bile duct blockage?

A
  • jaundice
  • nausea
  • itching
  • anorexia
22
Q

What diagnostic test can be used to determine CBD pathology?

A

LFTs

23
Q

What causes itching in blockage of common bile duct?

A

High level of bilirubin in blood that enters bloodstream after being backed up by blockage

24
Q

What are two common causes of acute pancreatitis?

A
  • alcohol

- gallstones

25
Q

How does gallstone enter the GI tract in gallstone ileus?

A

Through a fistula between the duodenum and gallbladder (formed as a result of inflammation and necrosis)

26
Q

What kind of pain does gallstone ileus cause?

A

Intermittent colic

27
Q

What is treatment for gallstone ileus? (urgent and 3 months later?)

A
  • urgent laparotomy to remove stone

- 3 months later cholecystectomy

28
Q

What is cholangiocarcinoma?

A

Cancer of the bile ducts

29
Q

What are 4 symptoms of colangiocarcinoma?

A
  • jaundice
  • lethargy
  • weight loss
  • anorexia
30
Q

What are 2 common metastases of cholangiocarcinoma?

A
  • lymph nodes metastases

- peritoneal metastases

31
Q

What are some imaging tests done to stage cholangiocarcinoma?

A
  • duplex ultrasound
  • CT
  • ERCP
  • PTC
  • MRI/MRCP
32
Q

What is a PTC test used for?

A

contrast medium injected into bile duct and then patient is x-rayed to check for blockage in bile duct

33
Q

What is the only curative treatment in cholangiocarcinoma?

A

bile duct and liver resection

34
Q

What is the palliative treatment in cholangiocarcinoma?

A

biliary stent

GI (29 decks)

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