FN: Biliary Colic Flashcards Preview

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Flashcards in FN: Biliary Colic Deck (10):
1

Pathogenesis

Gallbladder spasm against a stone impacted in the neck of the gallbladder - HArtmanns Pouch
Less ocmmonly, the stone may be in the CBD

2

Presentation

RUQ pain radiating - back (scapula region)
Assoc. with sweating, pallor, n/v
Attacks may be ppted. by fatty food and last

3

Differential

Cholecystitis/other gallstone disease
PAncreatitis
Bowel perforation

4

Investigations

Same work up as cholecysitis as may be difficult to differentiate clinically
Urine: bilirubin, urobilinogen, Hb
Bloods: FBC, U+E, amylase, LFTs,G+S, clotting, CRP

5

Imaging

AXR: 10% gallstones are radio-opaque
Erect CXR: look for perforation
US:
1. Stones: accoustic shadow
2. Dolated ducts: 6mm
3. Inflamed GB: wall oedema

6

If diagnosis uncertain after US

HIDA cholescintigraphy: shows failure of GB filling (requires functioning liver)

7

If dilated ducts seen on US -->

MRCP

8

Treatment

conservative vs. Surgical

9

Conservative

Rehydrate and NBM
Opiod analgesia: morphine 5-0mg/2h max
High recurrence rate therefore surgical Rx favoured

10

Surgical

As for conservative + eother:
1. Urgent lap chole (same admission)
Elective lap chole @ 6-12 wks

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