Diseases of the Gall-bladder + Biliary System

Question 1

5 Fs of Gallstones

Answer 1

Female, fat, forty, fair, foetus

Question 2

Other causes of gallstones

Answer 2

Drugs, cirrhosis, diabetes

Question 3

Types of gallstones

Answer 3

Cholesterol, pigment (bilirubin), mixed

Question 4

Pigment gallstones are caused by?

Answer 4

Excess bilirubin - haemolytic anaemia

Question 5

Cholesterol gallstones are caused by?

Answer 5

Obesity, hyperlipidaemia, genetics

Question 6

Where is bile produced?

Answer 6

Liver

Question 7

What does the gallbladder do to bile?

Answer 7

Concentrates and stores it

Question 8

What releases bile from GB into duodenum and what do it release through?

Answer 8

CCK

Through common bile duck and ampulla of Vater through major duodenal papilla

Question 9

Factors that increase risk of gallstones

Answer 9

GB pH, mucosal glycoproteins, inflammation of biliary duct

Question 10

Two presentations of gallstones

Answer 10

Biliary colic and acute cholecystitis

Question 11

What is biliary colic?

Answer 11

Infection of cystic duct due to stone

Question 12

Presentation of biliary colic

Answer 12

RUQ colicky pain (radiates to back)

Nausea + vomiting

Question 13

Presentation of acute cholecystitis

Answer 13

RUQ pain (radiates to R shoulder) + fever
Vomiting, pyrexia, tenderness, guarding, MURPHY's SIGN

Question 14

What is Murphy’s sign

Answer 14

Arrest of inspiration on palpation of RUQ

Question 15

Complications of gallstones

Answer 15

Biliary colic, acute/chronic cholecystitis, empyema, mucocele, obstructive jaundice, pancreatitis, cholangitis, gallstone ileus, carcinoma

Question 16

What is gallstone ileus?

Answer 16

Stone erodes through GB into duodenum and may obstruct terminal ileum

Question 17

Symptoms of gallstone ileus

Answer 17

Vomiting, abdo distention, dehydration, silent abdomen

Question 18

How to prevent gallstone ileus

Answer 18

Minimun operation trauma
Laparoscopic techniques
Avoid intra-abdominal sepsis

Question 19

Treatment of Gallstones

Answer 19

1. Laparoscopic cholecystectomy (urgent if acute cholecystitis) + IV fluids + antibiotics
2. Urodeoxycholic acid if small or too unfit for surgery

Question 20

What is ascending cholangitis?

Answer 20

Gallstones impact in common bile duct –> infection of biliary system

Question 21

Symptoms of ascending cholangitis

Answer 21

Charcoat’s triad: Jaundice, fever, RUQ pain

Pale stools, dark urine, pruitis (itch)

Question 22

Investigation of ascending cholangitis

Answer 22

1. Ultrasound
2. ERCP to diagnose and relieve
3. LFTs - obstructive, FBC, U+E, elevated CRP

Question 23

Treatment of ascending cholangitis

Answer 23

ERCP removal/stenting

Laparoscopic cholecystectomy

Question 24

What is primary sclerosing cholangitis

Answer 24

Progressive cholectasis with fibrosis and inflammation of bile ducts + strictures

Question 25

Presentation of primary sclerosing cholangitis

Answer 25

RUQ pain, pruitis, fatigue

Question 26

Risk of what is increased by primary sclerosing cholangitis

Answer 26

Cholangiocarcinomas, colorectal cancers

Question 27

Histology of primary sclerosing cholangitis

Answer 27

Onion-skinning fibrosis + beading of bile ducts

Question 28

Investigations of primary sclerosing cholangitis

Answer 28

Cholestatic LFTs | p-ANCA and ANA +ve

Question 29

Treatment of primary sclerosing cholangitis

Answer 29

Prednisolone, methotrexate

Question 30

Types of biliary tumours

Answer 30

Cholangiocarcinoma and adenocarcinoma of GB

Question 31

What is primary sclerosing cholangitis associated with?

Answer 31

UC

Question 32

Investigations of cholangiocarcinoma

Answer 32

Obstructive LFTs, US, spiral CT/ERCP, MRI scan

Question 33

Treatment of cholangiocarcinoma

Answer 33

``` Surgical resection (only cure) +bile duct and liver resection ```

Question 34

What is adenocarcinoma of GB associated with?

Answer 34

Diffuse calcification due to chronic end-stage cholecystitis

Question 35

What can adenocarcinoma of GB arise from?

Answer 35

Polyps

Question 36

Age of patients with adenocarcinoma of GB

Answer 36

Early 60s

Question 37

5 year survival of adenocarcinoma of GB after diagnosis

Answer 37

< 5%