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Flashcards in gallstones Deck (29)
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1
Q

biliary colic pain

A
intermittent pain
epigastric pain/ruq pain
can radiate to scapular)?
gallbladder stones 
after eating fatty food
2
Q

cholecystitis presentation

A
constant pain
inflammation peritoneum
not jaundiced
RUQ pain
gallstones in gallbladder PLUS inflammation
3
Q

cholangitis acute presentation

A
charcot triad
fever
RUQ pain
jaundiced
-dark urine
-pale stools 
-obstructed cholestatic jaundice
4
Q

visceral versus somatic pain

A

visceral

  • autonomic= related to arterial blood supply
  • intermittent pain

somatic

  • constant pain
  • t4 to t1
  • localised to anatomy
  • inflammation of the peritoneum
5
Q

where does liver and spleen and gallbladder and diaphragm refer pain too

A

liver=right
spleen=left
gallbladder=right scapula
diaphragm=shoulder

6
Q

presentation of gallstones

A
asymptomatic
biliary colic
cholecystitis
empyema- pleuritis
mucocoele: distended gb
obstructive jaundice
acute cholangitis
acute pancreatitis
gallstone ileus
gallbladder cancer
pain assoc. to fatty meal
7
Q

risk factor for gallstones 5F

A
fat or rapid weight loss
female
fertile
fair (Caucasian)
forty >
8
Q

how much bile is made a day

A

0.2-0.6 grams a day

9
Q

how much bile is resorbed a day

A

12-32 grams

10
Q

how large is the bile salt pool and how often does it cycle

A

2-4 grams

6-12 cycles a day

11
Q

faecal loss of bile a day

A

0.2-0.6

12
Q

3 main constituents of gallstones

A

cholesterol
calcium salts
bile pigments

13
Q

what has to be imbalanced to make gallstones

A

bile salts
cholesterol
phospholipids

14
Q

3 types of gallstones and % prevalence and causes

A
cholesterol 20%
-5f's
-contraceptive pill, low fibre
-terminal ileal disease
pigmented stone 5%
-haemolytic anaemia
mixed 75%
-calcium bilirubinate and cholesterol
15
Q

management of biliary colic

A

imaging for gallstones

laprascopic cholecystectomy

16
Q

acalculous cholecytitis meaning

A

patient with intercurrent illness ie inflammation of the gallbladder but no gallstones

17
Q

ERCP risks

A

bleeding
duodenal perforation
cholangitis
pancreatitis

18
Q

word for gallstones in the gallbladder

A

cholecystolithiasis

19
Q

word for gallstones in the cbd

A

choledocholithiasis

20
Q

biliary disease dx diff

A
peptic ulcer disease
GORD
acute pancreatitis
acute appenditicitis
renal pathology
IBS
21
Q

biliary colic DX

A
blood tests 
-WCC normal
-LFT normal 
-amylase normal
USS
22
Q

management principle for biliary colic

A
TREAT ONLY IF SYMPTOMATIC
-conservative: low fat diet
-medical: 
ursodeoxycholic acid
-surgical:
lithotripsy
cholecystectomy
23
Q

advantages and disadvantage of laparascopic cholecystectomy

A
-increased risk bile duct injury
\+
- decrease pain
-earlier discharge
-function
-improved cosmesis
24
Q

presentation of acute cholecystitis

A
epigastric/ RUQ pain
biliary colic
more constant pain also
radiation to shoulder tip/right scapula
anorexia/nausea/vomit
fever
25
Q

diagnosis of cholecystitis

A
USS for gallstones
Murphy's sign: inspire
tenderness
palpable gallbladder
peripheral blood leucocytosis 
check amylase 
lft NORMAL
WBC-neutrophilia
26
Q

management of acute cholecytitis

A
  • fluid resus
  • dalteparin
  • surgery- have to wait and often come back as elective for cholecystectomy when inflammation reduced >6weeks
27
Q

acute cholangitis investigations

A

-LFT elevated bilirubin, ALP
-Coagulation(prothrombin time)
-USS-MRCP-ERCP
charcot triad
septic
-amylase
-leucocytosis

28
Q

management of acute cholangitis and which antibiotic to use

A
Treat sepsis 6
-tazocin
or
-amoxicillin, and gentamicin and metronidazole 
-vitamin K for coagulopathy
-ERCP +/- stent insertion
-Cholecystectomy elective later on
29
Q

what would be seen on an ERCP of acute cholangitis

A

upstream dilation of the bile duct