*Biliary Tract and Pancreas Disorders 2 (Lecture 10) Flashcards Preview

Study Notes - Gastroenterology > *Biliary Tract and Pancreas Disorders 2 (Lecture 10) > Flashcards

Flashcards in *Biliary Tract and Pancreas Disorders 2 (Lecture 10) Deck (32)
Loading flashcards...
1

What are the 2 categories of biliary tract disease?

Gallstones
Bile duct cancer

2

Do most gallstones cause symptoms?

No, most are asymptomatic (10-30% of local population have gallstones)

3

What problems can symptomatic gallstones cause? (6)

Colic
Cholecystitis
Cholangitis
Jaundice
Pancreatitis
Bowel obstruction (gallstone ileus)

4

What is biliary colic?

term used to describe a type of pain related to the gallbladder that occurs when a gallstone transiently obstructs the cystic duct and the gallbladder contracts

5

What are the risk factors for the development of gallstones? (10)

5 Fs:
Female
Fat (obesity, high fat diet)
Forty/ fifty
Fertile (pregnancy)
Fair (more common in caucasians)
Also:
Bile salt loss (Crohns)
Diabetes
Dysmotility of GB
Prolonged fasting
TPN

6

What type of gallstones are pure black?

Pigment

7

What is a 4th rare type of gallstones?

Primary bile duct stones (choledocholithiasis)

8

What are the features of biliary colic?

Gradual build up pain in RUQ (when it eases it leaves a bruised/ aching feeling for a few days - can also cause epigastric pain)
Radiates to back/ shoulder
Associated with indigestion/ nausea

9

Does acute cholecystitis cause gallbladder distension?
Does chronic cholecystitis cause gallbladder distension?

Acute = distended
Chronic = not distended

10

When does gallstone pain tend to come on?

After eating a big fatty meal

11

How are gallstones diagnosed?

US
CT scan
MRCP/ ERCP
HIDA
EUS

12

What is a HIDA scan?

stands for hepatobiliary iminodiacetic acid scan, creates pictures of your liver, gallbladder, biliary tract and small intestine

13

What is the treatment of biliary colic? (5)

Pain killers
Low fat diet/ lose weight if obese
Observe in 3-6 months
If the patient is getting recurrent episodes of pain consider elective cholecystectomy
If patient unfit, try to dissolve gallstones with ursodeoxycholic acid

14

Treatment of acute cholecystitis? (5)

IV antibiotics and IV fluids
Nil by mouth
US to confirm diagnosis
Urgent cholecystectomy (asap) OR
Internal cholecystectomy depending on how inflamed the gall bladder s (antibiotics and come back in 3 months)

15

What complications of gallstones occur when the stone migrate into the CBD? (3)

Jaundice
Cholangitis
Acute pancreatitis

16

What is the difference between biliary colic and cholecystitis?

When the stone(s) passes into the cystic duct it causes pain and is called biliary colic
If this occurs for a prolonged period of time, it causes gallbladder inflammation (cholecystitis)

17

What is cholangitis?

Inflammation of the bile duct system that is usually related to a bacterial infection - usually caused by a bloackage

18

What symptoms suggest a common bile duct pathology? (5)

Itch
Nausea
Anorexia
Jaundice
Abnormal LFTs

19

What does ERCP stand for?

Endoscopic retrograde cholangio pancreatography

20

What is ERCP used for?

Diagnosis and treatment of pancreatic and bile duct problems e.g. gallstone removal

21

How can stones within the CBD be removed?

ERCP
Laparoscopically
Open surgery

22

How is acute pancreatitis due to gallstones treated?

Cholecystectomy
ERCP/ ES if frail

23

What is gallstone ileus?
How does it form?

Small bowel obstruction due to gallstone impacted in distal ileum
Fistula forms between the gallbladder and duodenum allowing a large gallstone to pass into the small intestine causing obstruction (moves down the SB causing intermittent colic, present with distal SB obstruction)

24

What is colic?

form of pain that starts and stops abruptly. It occurs due to muscular contractions of a hollow tube (colon, ureter, gall bladder, etc.) in an attempt to relieve an obstruction by forcing content out.

25

How is gallstone ileus treated?

Urgent laparotomy
SB enterotomy to remove stone
Interval cholecystectomy in 3 months (if the patient is old and frail the stone is removed and there is not usually a cholecystectomy)

26

What type of patients does gallstone ileus normally occur in?

Elderly women

27

How do patients with cholangiocarcinoma usually present? (6)

Jaundice
Weight loss
Anorexia
Lethargy
50% = lymph node metastases
20-30% = peritoneal metastases

28

Staging/ assessment of cholangiocarcinoma?

Duplex US
CT/ ERCP/ PTC
MRI/ MRCP/ MRA

29

what is PTC?

Precutaneous transhepatic cholangiography - 1dye delineates the biliary tract on the x-ray images and reveals any significant abnormalities

30

What is MRA?

Magnetic resonance angiography