Biliary tract Flashcards
Gallstones, Colic, PSC, PBC, cholecystitis (30 cards)
RFs for gallstones
- 4 Fs: Fat, Female, fertile (pregnancy), forty
- Diabetes
- Crohn’s disease
- COCP
Explain the pathophysiology of biliary colic
- occur due to ↑ cholesterol, ↓ bile salts and biliary stasis
- the pain occurs due to the gallbladder contracting against a stone lodged in the cystic duct
Describe the features of biliary colic
- colicky right upper quadrant abdominal pain
- worse postprandially, worse after fatty foods
- may radiate to the right shoulder
- nausea and vomiting
- No fever, normal LFTs and inflammatory markers
How are gallstones investigated
- abdominal ultrasound
- LFTs
- magnetic resonance cholangiography
What is the treatment of choice for biliary colic
elective laparoscopic cholecystectomy
What is acute cholecystitis
inflammation of the gallbladder
pathophysiology of acute cholecystitis
- 90% occur secondary to gallstones
- 10% referred to as acalculous cholecystitis: seen in hospitalised and severely ill patients
Features of acute cholecystitis
- RUQ pain that may radiate to the right shoulder
- Fever and signs of systemic upset
- Murphy’s sign on exam: inspiratory arrest upon palpation of the RUQ
Investigations for acute cholecystitis
- 1st: ultrasound - thickened wall, stones, fluid
- LFTs: typically normally
How is acute cholecystitis managed
- IV antibiotics
- early laparoscopic cholecystectomy, within 1 week (ideally 72hrs) of diagnosis
What is acute cholangitis
infection and inflammation of the biliary tree
What are the 2 main causes of acute cholangitis
- gallstones in the common bile duct
- benign/ malignant biliary tree strictures
Common causative organisms for acute cholangitis
- E.coli
- klebsiella
- enterococcus
Features of acute cholangitis
- Charcot’s triad: RUQ pain (70%), fever (90%) and jaundice (60%)
- hypotension and confusion + Charcot’s triad = Reynolds’ pentad
Investigations for acute cholangitis
- raised inflammatory markers
- 1st line: Abdo USS - bile duct dilation and CBD stones
- deranged LFTs
Management of acute cholangitis
- IV antibiotics
- endoscopic retrograde cholangiopancreatography (ERCP) within 48 hours to relieve any obstruction
What is primary biliary cholangitis
Thought to be an autoimmune condition
* Small intrahepatic bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis
RFs for primary biliary cholangitis
- Middle aged: age 40-65
- female (significant 10x)
Give 4 conditions associated with primary biliary cholangitis
- Sjogren’s syndrome
- rheumatoid arthritis
- systemic sclerosis
- thyroid disease
Presentation of primary biliary cholangitis
- may be asymptomatic
- pruritus
- fatigue
- hepatomegaly
- abdo pain/ discomfort
- xanthelasmas, xanthomata ( cholesterol deposits)
How is primary biliary cholangitis investigated
- LFTs: particularly raised ALP
- Immunology: anti-mitochondrial antibodies (specific), raised serum IgM
- Imaging: abdo ultrasound or magnetic resonance cholangiopancreatography (MRCP)
Management of primary biliary cholangitis
- ursodeoxycholic acid: slows disease progression and improves symptoms
- pruritus: cholestyramine
- fat-soluble vitamin supplements
- liver transplantation: end-stage liver disease
Complications of primary biliary cholangitis
- cirrhosis → portal hypertension → ascites, variceal haemorrhage
- Hypercholesterolaemia
- osteomalacia and osteoporosis
- hepatocellular carcinoma
What is primary sclerosing cholangitis
condition characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts
