Acute Cholecystitis And Biliary Colic Flashcards Preview

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Flashcards in Acute Cholecystitis And Biliary Colic Deck (16)
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1

Gallstone RF

Fair
Fat
Fertile
Female
Forty

2

Gallstone cause

Chol synth in liver. Is rel insol, held in sol by plips and bile salts.
Excess chol vs bile salt leads to lithogenic bile.
Stasis (oestrogen in preg) and gb dysfunc has a role.
Nidus of infec.
Crohns or hemicolectomy reduc bile salt reabs.

3

Gallstone types

chol domin mixed- most comm.
Black pigm stones- haemolytic anaemia (oxidised unconjug bili and Ca). Us in gb.
Brown bili, Ca, acid and bact action- anywh in bil tree.

4

Bil colic due to gallst obstruc cystic duct
Px

RUQ epig pain. Colicky but never stops compl.
Abrupt onset
May be exacerbated by fatty food
NV
NO SYS RESP eg WCC, pyrexia. No infec or inflamm.
GORD is a diff.

5

acute cholecystitis due to gallst
Stone stick longer cause inflamm and press. And water in bile is abs so more irritant.
Px

Inflamm and parietal perit inv
Local tenderness and peritonism
Pos murphys sign. Push and inhlae cause pain on R only.
IS SYS RESP eg high WCC and pyrexia
THICK GB WALL ON US.

6

Gallstone ileus rare

Gallstone to SI via eg fistual to duod.
Block narrow termin ileul and compacts.
Causes SI obstruc.

7

Gallstone ix

FBC, CRP, LFT, amylase, UE, WCC
High ALP and bili
High ALT indics hepatic jaundice cause
US- CBD and intrahepatic duct dilat
MRCP if susp CBD stone

8

Gallstone mx

Analgesia
Fluids
IV AB if cholecystitis (ecoli and kleb)
Lap chole
MRCP, ERCP if CBD stone- tx by chole with CBD exploration.
Other-
US lithotripsy
Percut drain if unfit for surg
ERCP alone to prev pancreatitis and jaund only

9

Gallstone complics

Bil colic
Cholecystitis
Mucocoele
Gangrene or perforat
Empyeme
Fistula
Mirizzi synd
Gb cancer
Obstructive jaundice
Cholangitis
Acute pancreatitis
Gallstone ileus
Choledocholithiasis- CBD stones
Charcots triad- fever, RUQ pain, jaund
Reynolds pentad- charcot plus mental obtundation and shock
Pancreatitis- LFT and amylase

10

Pre hepatic jaund

Haemolysis
Gilberts
Crigler nagler

11

Hepatic jaund

Viral hep
Alc hep
Drug induced eg penicillins
Cirrhosis

12

Post hepatic jaund

Gallstone
Stricture
AI- sclerosing cholangitis, AI pancreatitis
Congenital eg choledochal cysts

13

Obstruc jaund malig

Hilar cholangiocarcinoma
Gb CA
Distal cholangiocarcinoma
Ampullary tum
Panc tum- most comm

14

Obstruc jaund ix

Hx- pain, fever, itch, alc, drugs, dark urine, pale poo.
Mass, hepatomeg, spenomeg, stigmata liver dis.
LFT, UE, FBC, ALP, bili
US
CT if periampullary
MRCP if other

15

Covoisiers law

Palpab gb and jaundlikely panc CA
As LT gallstone would cause shrink

16

Obstruc jaund mx

CBD stones- ERCP, surg
Strictures- hepatojejunostomy
AI- steroid, ERCP, balloon, dilat
Malig- resection uncomm, palliative