Biliary Tract Disease Flashcards
(27 cards)
What is biliary colic?
Pain associated with the temporary obstruction of the cystic or common bile duct by a stone migrating from the gallbladder
What is cholecystitis?
Gallbladder inflammation
What are the two types of gallstones?
- Cholesterol gallstone
- Bile pigment stones
What are the complications of a gallstone located in the gallbladder and the cystic duct?
- Biliary colic
- Acute cholecystitis
- Empyema - gallbladder filling with pis
- Carcinoma
What are the complications of a gallstone lodged in the bile ducts?
- Obstructive jaundice
- Cholangitis - inflammation of the bile duct
- Pancreatitis
What are the main causes of gallstones?
- Obesity and rapid weight loss
- Diabetes
- OCP
How is a cholesterol stone formed?
- Cholesterol comes out of solution held by bile salts and phospholipids and crystallises to form stones
- Due to either excess cholesterol or decrease in bile salts
How are bile pigmented stones formed?
- Haemolysis leads to excess bilirubin - which binds to calcium to form black pigmented stones
What are brown pigmented stones?
- Usually and infected stone caused as a result of biliary stasis
What is ascending cholangitis?
Bile duct inflammation as a result of CBD obstruction
What are the risk factors for ascending cholangitis?
- Female
- Obesity
- Fatty foods
- Fertile
- Smoking
What is the nature of biliary colic pain?
- Sudden onset
- Severe
- Crescendo
- RUQ
- Radiation may go to shoulder
What is charcots triad presentation in ascending cholangitis?
- Fever
- Biliary colic
- Jaundice
Describe the differences in the presentation between Biliary colic, Acute cholecystitis and Ascending cholangitis ?
RUQ Fever Jaundice
Biliary colic yes no no
Acute cholecystitis yes yes no
Ascending cholangitis yes yes yes
What investigations would you do in someone with biliary colic?
Abdominal ultrasound is the most useful for diagnosing gallstone disease? But colic itself is unlikely to be associated with any significant abnormality in tests §
What would you see on the blood test in acute cholecystitis?
- Raise WCC and CRP
- raised serum bilirubin, APT and ATL levels
What would you see on the abdominal ultrasound in someone with acute cholecystitis?
- Think walled, shrunken gallbladder
- Pericholecystic fluid
- Stones
What examination would you do in suspected acute cholecystitis?
- RUQ tenderness
- Murphys sign
What would you see on the blood tests in someone with ascending cholangitis?
- Elevated neutrophil count
- Raised ESR and CRP
- Raised bilirubin - if bile duct obstruction is high
- Raised serum alkaline phosphatase
- Amino transferase levels are elevated
What would you see on a transabdominal ultrasound in someone with ascending cholangitis?
- Dilation of CBD
- May or may not show cause of obstruction
Distal CBD stones are easily missed
What would you seen magnetic resonance cholangiography in someone with ascending cholangitis?
Clearly shows biliary treat so you can detect CBD stones
What is the complication with a gallstone moving to the CBD?
Obstructive jaundice as bilirubin is backed up into the liver and leaks out into the blood
What is the treatment for symptomatic gallbladder stones?
Laparoscopic cholecystectomy
What is the pharmacological treatment for gallstones?
- Analgesia
- IV antibiotics
- Cholecystectomy
