Biliary Tract Disease Flashcards Preview

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Flashcards in Biliary Tract Disease Deck (23):
1

What are components of bile?

Bile pigments from broken down Hb
Cholesterol
Phospholipids

2

If concentration between different stones vary different stones form, what are 3 types of stone?

Pigment stones (<10%) – small, friable, irregular – haemolysis

Cholesterol stones – large, often solitary – age, obesity, female sex

Mixed stones - faceted (calcium salts, pigment and cholesterol)

3

90% of stones are asymptomatic, what are risk factors for them becoming symptomatic?

smoking
Parity (giving birth)

4

What is acute cholecystitis?

Follows stone or sludge impaction at the neck of the gallbladder. Causes inflammation

5

How does acute cholecystitis present?

continuous epigastric or RUQ pain – referred to right shoulder

Vomitting
Fever
Peritonism
GB mass

6

In biliary colic, pain occurs when a gall stone blocks the cystic duct or common bile duct. How does acute cholecystitis differ from binary colic?

Inflammatory component in acute cholecystitis (fever, WCC, local peritonism)
There is no inflammatory component in biliary colic

7

If a gall stone moves into and obstructs the common bile duct what occurs?

Obstructive jaundice and cholangitis (inflammation of bile ducts)

8

Murphy's sign is indicative of acute cholecystitis, what is Murphy's sign?

2 fingers over right upper quadrant
Ask to breath in
Inflamed gallbladder causes pain and arrest of inspiration

9

Tests for acute cholecystitis?

High WCC

Ultrasound- thick walled, shrunken GB, pericholecystic fluid, stones, CBD dilation

HIDA cholescintigraphy (nuclear imaging technique)

AXR identifies 10% of stones, may show calcified gallbladder

10

Treatment of acute cholecystitis

Nil by mouth
Pain relief
IV fluids
Cefuroxime
Laparoscopic cholecystectomy – either acute or delayed – is treatment of choice

11

What is chronic cholecystitis
How does it present

Chronic gallbladder inflammation +- colic
Flatulent dyspepsia

12

What is flatulent dyspepsia?

Vague abdominal discomfort, distention, nausea, flatulence and fat intolerance

13

What is colic?

Pain that starts and stops abruptly. It occurs due to muscular contractions of a hollow tube, in an attempt to relieve an obstruction by forcing content out.

14

Tests for chronic cholecystitis?

Ultrasound to image stones and assess CBD diameter

MRCP (magnetic resonance cholangiopancreatography)
to find CBD stones

15

Treatment for chronic cholecystitis?

cholecystectomy

16

What is biliary colic?

Pain due to a gall stone temporarily blocking the cystic duct or bile duct

(no inflammation)

17

How does biliary colic present clinically?

RUQ pain radiates tot he back +- jaundice

18

Treatment of biliary colic

Analgesia
Nill by mouth
Rehydrate
Elective cholecystectomy

19

How does cholangitis (biliary tract inflammation) present?

RUQ pain, rigors, jaundice- Charcot's triad

20

How is cholangitis treated?

Cefuroxime and Metronidazole

21

Complications of gallstones in gallbladder and cystic duct

Biliary colic
Acute and chronic cholecystitis
Mucocoele
Empyema
Carcinoma
Mirizzi syndrome

22

Complications of gallstones in bile ducts

Obstructive jaundice
Cholangitis
Pancreatitis

23

Complications of gallstones in the gut

Gallstone ileus