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3A week 4 - HPB, malabsoprtion and EDs > gallstones (see DM) > Flashcards

gallstones (see DM) Flashcards

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1
Q

what is bile composed of (5)

A
  1. water (97%)
  2. bile acids/salts
  3. bile bigments - biliverdin, bilirubin
  4. lipids - cholesterol, fatty acids, phospholipids
  5. electrolytes
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2
Q

what are the functions of bile (6, top two are the major ones)

A
  1. emulsification of fats - allow for greater SA for enzyme activity
  2. neutralises gastric secretions
  3. absoption of fats and fat-soluble vitamins (ADEK)
  4. excretion of substances e.g. bile pigments, excess cholesterol
  5. laxative and lubrication for chyme
  6. bacteriocidal
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3
Q

what are the 3 main types of gall stones

A
  1. cholesterol stones - due to excess cholesterol production
  2. pigment stones - purely comprised of bile pigments, may arise due to haemolytic anaemaia
  3. mixed - mixture of the two
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4
Q

why might gallstones not be seen on x-rays

A

most don’t contain enough calcium to appear opaque on xray

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5
Q

what are the 5 Fs of gallstones (epidemiology)

A
  1. fat
  2. female
  3. fertile
  4. forty
  5. family history
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6
Q

what is a complication of gallstones due to vitamin malabsoption

A

clotting disorder -> vit K needed in clotting factor synthesis

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7
Q

what conditions may predispose a pt to gallstones (4)

A
  1. cystic fibrosis
  2. cirrhosis
  3. impaired gall bladder emptying
  4. haemolytic anaemia
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8
Q

where does the common bile duct drain into

A

the duodenum

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9
Q

what are some common areas that gallstones can cause blockages at (3)

A
  1. cystic duct
  2. common bile duct
  3. convergence of common bile and pancreatic duct
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10
Q

where can gallstones cause complications

A
  1. in the gall baldder (choleithiasis)
  2. in the biliary system (choledocholithiasis)
  3. outside the biliary system (e.g. GI tracts)
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11
Q

complications of gallstones (8)

A
  1. biliary colic
  2. cholecystitis
  3. mirizzi syndrome (common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder)
  4. obstructive jaundice
  5. ascending cholangitis
  6. acute obstructive suppurative ascending cholangitis
  7. pancreatitis
  8. gallstone ileus
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12
Q

what is bilary colic

A

spasm of cystic duct due to calculi causing blockages

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13
Q

what precipitates bilary colic

A

large fatty meal

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14
Q

biliary colic presentation

A

RUQ pain

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15
Q

biliary colic investigations + findings (2)

A
  1. bloods - normal
  2. US - gallstones, thin walled gall bladder
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16
Q

biliary colic mgx (2)

A
  1. analgesia
  2. elective cholecystectomy
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17
Q

what is cholecystitis

A

inflammation of the gall bladder -> progression of biliary colic leading to inflammation

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18
Q

cholecystitis presentation (3)

A
  1. RUQ pain
  2. murphy’s sign (unable to complete full inspiration when palpating due to pain)
  3. fever
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19
Q

cholecystitis investigations + findings (2)

A
  1. bloods - raised WCC, CRP, normal LFTs
  2. USS - gallstones, thick-walled gallbladder
20
Q

cholecystitis mgx (5)

A
  1. Abx - broad spectrum (amoxicillin, gentamicin and metraniazole)
  2. analgesia
  3. “hot” cholecystectomy (Laparoscopic Cholecystectomy during an acute attack)
  4. delayed cholecystectomy (after abx etc.)
  5. cholecystostomy (drainage of gall bladder)
21
Q

what is mirizzi syndrome

A

common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder

22
Q

what can mirizzi syndrome progress to form

A

a fistula

23
Q

mirizzi syndrome investigations + results (3)

A
  1. bloods- raised WBC, CRP, obstructive LFTs (raised ALP and GGT)
  2. US - gallastones, thick walled gallbladder, dilated intrahepatic ducts
  3. MRCP
24
Q

mirizzi syndrome mgx (3)

A
  1. abx
  2. analgesia
  3. complex surgical mgx
25
Q

obstructive jaundice presentation (2)

A
  1. jaundice
  2. RUQ pain (if due to gall stones)
26
Q

what is Courvoisier’s law

A

if a pt has jaundice and a painLESS enlarged gall bladder it is most likley NOT due to gallstones but some other underlying cause e.g. pancreatic malignancy

27
Q

obstructive jaundice investigations and results

A
  1. bloods - obstructive LFTs (raised ALP and GGT)
  2. US - dilated common bile duct +/- intrahepatic ducts
  3. MRCP
28
Q

obstructive jaundice mgx

A

dependent on cause
1. Endoscopic retrograde cholangiopancreatography (ERCP);
2. cholecystectomy with CBD exploration

29
Q

what is ascending cholangitis

A

biiliary stasis in obstructive jaundice leading to infection

30
Q

ascending cholangitis presentation (4)

A
  1. jaundice
  2. RUQ pain
  3. fever
  4. charcot’s triad (pain, fever, jaundice/rigors)
31
Q

ascending cholangitis investigations and results (3)

A
  1. bloods - obstructive LFTs, raised WBC, raised CRP
  2. US - dilated common bile duct +/- intrahepatic ducts, thickening of bile duct walls
  3. MRCP
32
Q

what is suppurative cholangitis

A

accumulation of pus in the bile ducts - may lead to increased intrabiliary pressure and sepsis

32
Q

ascending cholangitis mgx

A
  1. abx
  2. resusitation
  3. biliary tree decompression - ERCP
33
Q

suppurative cholangitis presentation (5)

A
  1. jaundice
  2. RUQ pain
  3. fever
  4. hypotension
  5. mental obtundation
    (aka reynold’s pentad -> pain, obstructive jaundice, fever, hypotension, mental change)
34
Q

suppurative cholangitis investigations

A
  1. bloods - obstructive LFTs, raised WCC, raised CRP
  2. US - dilated common bile duct +/- intrahepatic duct
  3. MRCP
35
Q

suppurative cholangitis mgx

A
  1. abx
  2. resuscitation
  3. organ support
  4. intensive care
  5. ERCP
36
Q

pancreatitis presentation

A

epigastric pain that radiates to the back and is better on leaning forward

37
Q

pancreatitis investigations and findings

A
  1. bloods - amylase >100 or x3 higher than upper limit of normal, or lipase
  2. US - gallstones
  3. CT abdo + pelvis
38
Q

pancreatitis mgx

A
  1. supportive care (possibly intensive care)
  2. cholecystectomy (in uncomplicated cases), can be done immediately or 2 weeks post discharge
39
Q

what is gallstone ileus

A

small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine due to the formation of a cholecysto-enteric fistula

40
Q

gallstone ileus presentation (3)

A
  1. vomiting
  2. constipation
  3. hx of RUQ pain
41
Q

gallstone ileus investigations and findings (3)

A
  1. bloods - may be normal
  2. XR/CT - aerobilia, bowel obstruction, gallstones at ileocaecal junction (aka Rigler triad)
  3. CT abdomen/pelvis - rigler triad
42
Q

what is the rigler triad in gallstone ileus

A
  1. small bowel obstruction
  2. aerobilia - gas within the biliary tree
  3. gallstones (usually in the right iliac fossa)
43
Q

gallstone ileus mgx

A
  1. resusitation
  2. NG tube - drain fluid from stomach
  3. enterolithotomy - the extraction of a stone through an enterotomy, without performing a procedure to resolve the fistula or the gallbladder disease
44
Q

what is seen in the US of someone w a gallstone (2)

A
  1. high attenuation og the gall stone itself
  2. acoustic shadow below gallstone
45
Q

what is a porcelain gall bladder

A

calcification of the gallbladder wall

3A week 4 - HPB, malabsoprtion and EDs (3 decks)

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