what a gall(bladder) Flashcards
what are the different types of gallstones and how do they form
cholesterol stones - when there is too much cholesterol and the salts can’t hold it in solution any more OR because there is a limited number of bile salts so they can’t contain it OR due to gallbladder stasis
bilirubin stones - pigmented, due to too much bilirubin combining with calcium forming a precipitation - calcium bilirubinate (UCB)
brown stones - sign of infection, mix of UCB and phospholipids, common in Asian populations
what are risk factors for gallstones
how do gallstones present
Asian - brown
female/contraception - cholesterol
four Fs : female fat forty fertile
Severe, colicky epigastric or RUQ pain Triggered by meals (particularly high fat meals) Lasting 30 minutes - 8 hours May have nausea and vomiting jaundice acute cholecystitis pancreatitis cholangitis (bile duct inflammation)
what are investigations and management for gallstones
LFTs - bilirubin if obstruction, raised ALP, ALT, AST
US
MRCP
ERCP
conservative if asymptomatic
lithotripsy
dissolution
gallbladder removal (cholecystectomy) if symptomatic- stones irritate the gallbladder and increase the risk of cancer
what is primary sclerosing cholangitis and what is primary biliary cholangitis
PSC - progressive cholestasis with bile duct inflammation and strictures
PBC - autoimmune attack of interlobular bile ducts causing inflammation leading to fibrosis, cirrhosis, portal hypertension
what are risk factors for primary sclerosing cholangitis
male 30-40 years ulcerative colitis chron's HLA
how does primary sclerosing cholangitis present
RUQ pain
hepatosplenomegaly
pruritis
what investigations could you do for primary sclerosing cholangitis
ERCP
MRCP
biopsy
bloods - increased ALT, increased conjugated bilirubin
anti-mitochondrial antibodies in serum in PBC
how could you treat primary sclerosing cholangitis
liver transplant
what are complications of primary sclerosing cholangitis
cirrhosis
what is ascending cholangitis
blockage in the common bile duct due to a gallstone
allows bacteria to travel up and infect
how does ascending cholangitis present
jaundice
fever
RUQ pain
what bacteria is commonly involved in ascending cholangitis
e.coli
enterococcus
klebsiella
how could you investigate ascending cholangitis
ERCP
bloods - raised CRP etc
how could you treat ascending cholangitis
rehydration
antibiotics
remove obstruction - ERCP to suction it out or shockwave lithotripsy to break down stone
stenting to widen ducts
can remove gallbladder to prevent further problems
what are complications of ascending cholangitis
septic shock
what is acute cholecystitis
gallstone becomes lodged in the cystic duct and causes inflammation of the gallbladder
the inflammation generates more fluids causing pressure to build up and worsen the situation
the stone usually falls back into place
if it doesn’t pressure builds until the gallbladder is compressing it’s arterial supply - ischaemia and rupture
how does acute cholecystitis
mid-epigastic pain (due to gallbladder contracting) that radiates to epigastrium, shoulders and scapula nausea vomiting rebound tenderness murphy's sign - pain on breathing in sharp pain if ruptures
what investigations could you do for acute cholecystitis
bloods - increased CB and ALP indicates liver involvement
US - gallbladder thickening, distention, sludge, stones
ERCP
how could you treat cholecystitis
cholecystectomy
what are complications of cholecystitis
sepsis
rupture
bile can back up into liver and enter the blood stream
what is chronic cholecystitis
repeated inflammation of the gallbladder due to stones constantly getting stuck and then dislodged in the cystic duct
how does chronic cholecystitis present
mid-epigastic to RUQ to scapula pain usually comes in bouts lasting about a month pain after meals nausea vomiting anorexia jaundice murphy's sign rebound tenderness
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what are complications of chronic cholecystitis
cancer - the epithelial wall of the gallbladder is constantly becoming inflamed and damaged putting it at a higher risk of cancer
what are types of gallbladder cancer
adenocarcinoma
cholangiocarcinoma
most are extrahepatic
what are risk factors for gallbladder cancer
repeated inflammation - acute cholecystitis
how could you treat gallbladder cancer
cholecystectomy - only curative option
chemo
stents
radio
