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Biliary Colic + Ascending Cholangitis Flashcards

1
Q

cause of biliary colic?

A

gallstones passing through biliary tree.

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2
Q

medical term for gallstones?

etymology of this word?

A

cholelithiasis

o Chole – gall
o Lith – stone

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3
Q

what are gallstones made of?

-3

A

 Cholesterol

 Pigment

 Mixed

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4
Q

what are most gallstones made of?

how many gallstones are made of this?

what is the colour if it made of said thing?

A

Cholesterol

80%

yellow

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5
Q

what is within bile naturally?

-3 things

A

cholesterol, bile salts, water

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6
Q

if the colour of the cholelithiasis is black.

what is it made of?

A

pigment

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7
Q

what are the 4f’s?

A

Female
Fat
Fertile
Forty

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8
Q

asides from the 4f’s what are some other risk factors?

-4

A

Diabetes mellitus
Crohn’s disease
Rapid weight loss
HRT + pill – oestrogen

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9
Q

how many cholelithiasis pts are asymptomatic?

%wise

A

80%

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10
Q

why would bariatric surgery be a RF for gallstone formation?

A

eating less – biliary stasis –> gallstones formed

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11
Q

why does the painful biliary colic happen?

A

Stone stuck in cystic duct –> gallbladder contracts against this

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12
Q

which IBD is a RF?

why?

A

Crohn’s

ileum does not reabsorb bile salts –> more cholesterol put into the bile.

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13
Q

which hormone which is often taken in drug form is RF?

why?

A

Oestrogen

↑amount of cholesterol the liver puts in bile

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14
Q

why is sickle cell disease a RF?

which type of cholelithiasis will be made?

A

Haemolysis - ↑bilirubin – pigment gallstones

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15
Q

most common complication?

classic sign for this complication?

A

Acute cholecystitis

+ve Murphy’s sign

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16
Q

which complication of cholelithiasis is a rare type of SBO?

what is the name of the fistula that was made to cause this complication?

A

Gallstone ileus

cholecystoduodenal fistula

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17
Q

if gallstone is stuck in ampulla Vater,

what complication can happen?

A

Acute pancreatitis

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18
Q

which complication can happen that is as infection?

what is the classic triad for this called?

components of the triad?

A

Ascending cholangitis

Charcot’s triad

jaundice, fever, RUQ pain

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19
Q

someone has gall stones.

now has jaundice, pale stools, dark urine.

what complication is this?

where has this gallstone become stuck?

A

Obstructive jaundice

common bile duct

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20
Q

how will the pain be in cholethiasis?

  • where
  • character
  • worse
  • radiation
A

RUQ pain
colicky (crampy)
worse after fatty foods
radiate to shoulder

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21
Q

N&V is common.

true or false?

A

true

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22
Q

1st line Ix?

A

US

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23
Q

pt has cholelithiasis.

has now developed further symptoms and on bloods there is↑↑↑ALP, bilirubin.

what complication is this?

A

obstructive jaundice

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24
Q

pt has cholelithiasis.

has now developed further symptoms and on bloods there is:
↑↑↑amylase
↑↑↑lipase

what complication is this?

A

acute pancreatitis

25
pt has cholelithiasis. has now developed further symptoms and on bloods there is: ↑CRP what complication is this?
cholecystitis
26
1st line Management?
Laparoscopic cholecystectomy (elective)
27
what is the surgery for cholelithiasis called? etymology of word?
cholecystectomy o Chole - gall o Cyst - bladder
28
after surgery for cholelithiasis, what is the dietary advice for the pt?
no fatty foods
29
when waiting for surgery for cholelithiasis, what analgesia can be given for moderate pain? -2
paracetamol or diclofenac
30
when waiting for surgery for cholelithiasis, what analgesia can be given for severe pain? - class - give two examples
opioids | morphine, pethidine
31
which duct comes directly from the gall bladder?
cystic duct
32
which duct comes directly from the liver?
common hepatic duct
33
the pancreatic duct joins which duct? which new duct has now been made?
common bile duct ampulla of vater
34
common bile duct is made of which two ducts joining?
cystic duct | common hepatic duct
35
which muscular sphincter is at the end of the biliary tree at the opening to the duodenum?
sphincter of oddi
36
arterial blood supply to the gall bladder? | - begin with abdominal aorta
AA --> coeliac trunk --> common hepatic artery --> hepatic right hepatic artery --> cystic artery
37
venous drainage of the gall bladder? | - end with IVC
cystic vein --> portal vein --> hepatic vein --> IVC
38
where is bile made?
liver
39
where is bile stored?
gall bladder
40
effect of alcohol on sphincter at biliary tree/ duodenum? name of this sphincter? what can this cause?
contraction sphincter of oddi acute pancreatitis
41
artery to the gall bladder? what is this artery also known as?
cystic artery bachelor artery
42
artery to the cystic duct?
cystic artery
43
where is bile reabsorbed?
ileum
44
for ascending Cholangitis to even happens what must you have? what is the biggest cause of said thing?
obstruction gall stones
45
explain pathophysiology of ascending cholangitis?
OBSTRUCTION – ↑biliary intraluminal pressure – pushes bacteria up biliary tract – infection
46
in ascending cholangitis where does the bacteria come from?
duodenum
47
how does biliary obstruction affect immune system?
↓↓anti-bacterial defences
48
name three things that could obstruct the biliary tree and thus cause ascending cholangitis? -3
Gallstones ERCP Tumours
49
which triad is associated with ascending cholangitis? how often is this triad actually seen? -% range
Charcot’s triad | 20-50%
50
which triad is associated with ascending cholangitis? what are the components of the triad?
Charcot's triad RUQ pain, fever, jaundice
51
what is the most common symptom of ascending cholangitis?
Fever
52
what is ascending cholangitis (bascially)?
bacterial infection of biliary tree
53
which pentad can occur with ascending cholangitis? components of this pentad? what infective emergency complication should you be thinking of if this pentad occurs?
Reynold’s pentad Charcot’s triad + hypotension + confusion sepsis
54
pt has ascending cholangitis. 1st line Management? - group of drugs - route
IV antibiotics
55
pt has ascending cholangitis. severely unwell and not responding to the first line medical care. what surgery can be done for him/her? - name of surgery - method used - elective or urgent
biliary decompression ERCP urgent
56
pt has ascending cholangitis. he has responded to the first line medical care and is clinically stable. what is next step in management?
elective ERCP
57
diclofenac drug class? moa?
NSAIDs inhibits cyclooxygenase-1 and -2 so stops PG formation
58
usual bacteria that causes ascending cholangitis?
E.Coli

GI (25 decks)

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