wk 7 6 Biliary Tract Disease

Question 1

associated diseases of gallstone

Answer 1

colic
cholecystitis
jaundice
pancreatitis
bowel obstruction

Question 2

t/f gallstones mainly present assymptomatic

Answer 2

true

Question 3

t/f gallstones more likely in males

Answer 3

false

Question 4

how does gallstones arise

Answer 4

composition of bile - abnormal bile consumption
bile stasis
infection
excess cholesterol/bilirubin

Question 5

rarest form of gallstones

Answer 5

primary bile duct stones

majority are mixed cholesterol + pigment

Question 6

risk factors for gallstones

Answer 6

forty
female
high fat diet
fetal 
hyperlipidemia
diabetics 
dysmotility of GB
perenteral nutrition - eating stimulates CCK - contracts GB - parenteral = bile stasis

Question 7

which IBD is likely o develop gallstones

Answer 7

crohns - less absorption of bile salts

Question 8

gallstones can lead to fistulae t/f

Answer 8

true

gallstones erode wall into duodenum

Question 9

severe acute eppigastric pain could be

Answer 9

biliary colic
peptic ulcer
oesophageal spasm
MI acute pancreatitis

Question 10

in acute cholecystitis, which prostaglandins would be secreted

Answer 10

I2 and E2

Question 11

diagnosis of gallstones through

Answer 11

ultrasound (wall>3mm is thick and inflamed) (GOLD)
CT - good to check other organs once diagnosed and likely complications
MRCP (MRI)

if nothing from US/CT/MRCP
HIDA test used - shows dysmotility, <35% fraction= pathology/shows poor function of Oddi

EUS - ulstra and endoscope - microstones

Question 12

acute cholecystitis treatment

Answer 12

IV antibiotics
IV fluids
nil by mouth only if unable
duration dependent - up to 5 days may require urgent cholecystectomy
- more than 5 days - more dangerous for surgery siince inflammation incr blood flow to area
interval cholecystectomy - if inflammation reduced

Question 13

complications of gallstones

Answer 13

stones migrate to CBD

• jaundice
• cholangitis
• acute pancreatitis

gallstone ileus

Question 14

clinical presentation of CBD gallstones

Answer 14

itch, nausea,anorexia
jaundice
abnormal LFTs

Question 15

2 important factors indicating of gallstones

Answer 15

dilation of bile duct 60mm - 70mm ….

bilirubin / alkaline phos /ALT raised

Question 16

how does gallstones cause acute pancreatitis

Answer 16

gallstone obstructs near sphincter, causing backflow and inflammation

Question 17

blocked sphincter wil leead to

Answer 17

autodigestion of peri-pancreatic tissues by activated enzymes

Question 18

size required for galllstone to obstruct

Answer 18

> 3cm

Question 19

where does gallstone obstruct small intestines

Answer 19

distal ileum

Question 20

surgery used to treat symptomatic gallstones

Answer 20

laparoscopic cholecystectomy

Question 21

gallstones present but no symptoms, will thy be removed n

Answer 21

no

Question 22

majority of cholangiocarcinomas occur

Answer 22

upper third are, where gallbladder bile meets hepatic

Question 23

typical presentation of cholangiocarcinoma

Answer 23

jaundice
weight loss 
anorexia
lethargy
50% lymph node metastases/ 20-30% peritoneal metastasees

Question 24

outline stages fro cholangiocarcinoma

Answer 24

type 1 - below confluence
2 - confined to confluence
3a - extension into right hepatic 
3b - into left hepatic 
4 - into both ducts

Question 25

if cholangiocarcinoma cannot be resected, what is done instead

Answer 25

ERC/PTC insertion to drain