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Flashcards in Biliary tract disease Deck (24):
1

What causes biliary colic?

temporary obstruction of the cystic or CBD by a stone

2

Symptoms of biliary colic

RUQ pain
Radiates to the back
Often associated with vomiting

Jaundice may be present

3

Rx biliary colic

analgesia and elective cholecystectomy

rehydrate, NBM

4

Investigations biliary colic

US showing gallstones

increased serum alkaline phosphatase + bilirubin

5

what differentiates biliary colic from acute cholecystitis?

absence of inflammatory features

(fever, white cell count + local peritonism)

6

what is peritonism?

clinical signs of shock and peritonitis

7

what causes acute cholecystitis?

the impaction of a stone in the cystic duct or neck of the gallbladder

8

clinical feutres of acute cholecystitis?

RUQ pain, like biliary colic

fever + tenderness + muscle guarding

tenderness is worse on inspiration

9

complications acute cholecystitis?

pus and perforation with peritonitis

10

Ix acute cholecystitis

leucocytosis

abd US: gallstones, distended gallbladder with a thickened wall

serum liver biochem may be mildly abnormal

11

Mx acute cholecystitis

initially conservative: NBM, fluids, analgesia, IV antibiotics e.g. cefotaxime

colecystectomy done within 48hrs of the acute attack

12

Chronic cholecystitis is associated with what?

gallstones

(incidental finding)

13

US examination of chronic cholecystitis

may be small shrunken gallbladder

14

symptoms of chronic cholecystis

no evidence of any, and cholecystectomy not indicated

15

what is ascending cholangitis also known as?

acute cholangitis

16

what is acute cholangitis (+cause)

infection of biliary tree + occurs secondary to CBD obstruction by gallstones

other: benign biliary strictures after biliary surgery or associated with chronic pancreatitis, PSC, HIV cholangiopathy

17

Charcot's triad for acute cholangitis

(Not always present)
fever
jaundice
RUQ pain

18

What type of jaundice for acute cholangitis?

cholestatic
dark urine, pale stool, skin may itch

19

Ix acute cholangitis

leucocytosis

+ve blood cultures (e.g. E.coli)

liver biochem: cholestatic picture- raised serum Br and alkaline phosphatase

US: dilated CBD

ERCP: definitive Ix + allows drainage. site, cause + can sample bile

20

what does ERCP stand for?

Endoscopic retrograde cholangiopancreatography

21

Mx acute cholangitis

resuscitation + vol replacement, analgesia, IV antibiotics,

biliary drainage/clearance (ESRP)

stent if stones cannot be removed

22

what is choledocholithiasis

stones in the CBD

23

US choledocholithiasis

gallbladder stones
may show obstructed CBD containing a stones

24

Clinical presentation of CBD stones

may be asymptomatic with no features of cholangitis

abnormal liver biochem, usually cholestatic picture