ICL Cholecystitis - Week 5

Question 1

Biliary colic causes.

Answer 1

Obstruction in the cystic or common bile duct.

Question 2

Symptoms of biliary colic

Answer 2

• Nausea
• Vomiting
• RUQ pain w radiation to R shoulder

Question 3

2 x types of cholecystitis

Answer 3

• Calculous cholecystitis – caused by gallstones obstructing the cystic duct
• Acalculous cholecystitis – caused by dysfunction of gallbladder emptying

Question 4

Cholecystitis

Answer 4

Inflammation of the gallbladder.

Question 5

Symptoms of cholecystitis

Answer 5

• Severe & constant abdominal pain w radiation to R shoulder
• Mild jaundice
• Fever
• Tender gallbladder

Question 6

Complications of cholecystitis

Answer 6

Gangrene, rupture, empyema, fistula.

Question 7

Cholelithiasis symptoms

Answer 7

• Pain in RUQ w radiation to R scapula
• Nausea
• Vomiting
• Post-hepatic jaundice
• Pale stool
• Bloating & gas
• Dyspepsia
• Fatty or greasy food intolerance
• Post-prandial fullness
• Fever
• Abdominal tenderness (w +ve Murphy’s sign)

Question 8

Cholelithiasis

Answer 8

presence of gallstones in the gallbladder (may be asymptomatic).

Question 9

Choledocholithiasis

Answer 9

One of more gallstones in the common bile duct -> bile build-up.

Question 10

Choledocholithiasis symptoms

Answer 10

• RUQ abdominal pain
• Dark urine
• Pale stools
• Jaundice.

Question 11

Ascending cholangitis

Answer 11

Ascending bacterial infection & inflammation of the biliary tree, which disrupts the normal flow of bile.

Question 12

Symptoms of ascending cholangitis.

Answer 12

• Fever
• Jaundice
• RUQ pain

Question 13

Complications of ascending cholangitis

Answer 13

Sepsis.

Question 14

External duct blockage

Answer 14

(i.e., Mirizzi’s syndrome) via large gallstone/multiple gallstones in Hartman’s pouch -> flopping of gall bladder onto common bile duct/common hepatic duct -> external compression.

Question 15

Gallstone ileus

Answer 15

mechanical obstruction of GIT tract by gallstone after passing through the biliary-enteric fistula.

Question 16

Investigations for gallbladder/liver/pancreatic pathologies.

Answer 16

• FBC – white cell elevation may indicate infection or inflammation
• CRP – protein produced by the liver which may indicate liver or biliary tract damage/inflammation
• Bilirubin – elevated due to high amounts of bile in the gallbladder
• LFTs
• U&E – to check renal function & rule out complications
• CT/MRI – to help show thickening of the gallbladder wall or increased density of fatty tissue around the gallbladder wall
• Ultrasound – to help show gallstones, thickening of the gallbladder wall, distended gallbladder
• MRCP (magnetic resonance cholangiopancreatography) – used if the Ab USS doesn’t detect any gallstones.

Additional tests to consider:
o Arterial blood gas (ABG) can be performed to check for sepsis.
o Coagulation panel (PT/INR) can be performed if sepsis suspected.
o Blood culture can also be performed to check for potential causative bacterial infection.

Question 17

Risk factors for gallstones

Answer 17

• Oestrogen
• Female
• Age
• PMHx gallstones
• Rapid weight loss
• Fasting
• Obesity