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GIHEP > L11 + 12: Gallstones, Pancreatitis & Jaundice > Flashcards

L11 + 12: Gallstones, Pancreatitis & Jaundice Flashcards

(48 cards)

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1
Q

What is the function of the gall bladder?

A

storage + concentration of bile (not vital)

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2
Q

Which 2 components of bile aid in digesting fats?

A
  1. Bile Salts

2. Phospholipids

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3
Q

List 4 components of the bile which are excreted?

A
  1. Bilirubin
  2. Cholesterol
  3. Calcium Salts
  4. Copper
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4
Q

What is cholelithiasis? (definition)

A

gallstones in the gall bladder

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5
Q

What is choledocholithiasis? (definition)

A

gallstones in the CBD

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6
Q

Gallstones are predominantly composed of what?

A

Cholesterol

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7
Q

List some of the risk factors/predisposing factors for developing gallstones

A
  • female
  • increasing age
  • obesity
  • diet: high fat/low fibre; high lipids
  • T2DM
  • high dose oestrogen (pregnancy, OCP, HRT)
  • fertility
  • medications (clofibrate)
  • gall bladder hypomotility/stasis
  • haemolytic disorders
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8
Q

What illness can clofibrate cause? (hint: biliary-related)

A

gallstones

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9
Q

What can cause gallbladder hypomotility/stasis?

A
  • rapid weight loss (bariatric surgery)

- fasting

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10
Q

Bilirubin (pigment) gallstones are less common but they may occur. List some of the possible causes of these gallstones

A
  • bile salt depletion (Crohn’s ileitis, ileal surgery)
  • cirrhosis
  • haemolysis
  • parasites
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11
Q

Briefly describe the pathogenesis of gallstones

A
  • altered bile composition - lithogenic bile (increased cholesterol)
  • gall bladder hypomotility leading to bile stasis
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12
Q

List some of the symptoms of symptomatic gall stones

A
  • biliary colic
  • steady RUQ/epigastric pain
  • pain >30 mins and < 4 hours
  • pain may occur post-prandial (after eating due to CCK release)
  • may radiate to right shoulder/back
  • crescendo pattern
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13
Q

List 4 complications of gallstones

A
  1. Acute Cholecystitis
  2. Common Bile Duct Obstruction
  3. Mirizzi Syndrome
  4. Gall Bladder Adenocarcinoma
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14
Q

What is Mirizzi Syndrome?

A

extrinsic compression of the CBD by a gallstone impacted in the cystic duct/gall bladder

    • stone in Hartman’s pouch
    • causes obstructive jaundice
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15
Q

What is a porcelain gallbladder suggestive of?

A

Gall Bladder Adenocarcinoma

- the gall bladder becomes calcified and usually has long-standing gallstones

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16
Q

What is cholecystitis? (definition)

A

inflammation of the gall bladder

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17
Q

Acute cholecystitis may be a complication of gall stones if there is a…..

A

cystic duct obstruction

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18
Q

List the symptoms of acute cholecystitis

A
  • fever*
  • nausea
  • vomiting
  • pain in RUQ (for days)
  • RUQ tenderness*
  • positive Murphy’s sign*
  • high WCC*
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19
Q

What is the treatment/management plan for acute cholecystitis?

A
  • analgesia
  • abdominal US
  • ± IV empiric antibiotics
  • IV fluids
  • Nil Po if vomiting
  • Laparoscopic Cholescystectomy*
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20
Q

What are the main differences in symptoms in cholelithiasis (gallstones) and acute cholecystitis (inflammation of gall bladder)?

Study These Flashcards
A

in Acute Cholecystitis will have….

  • fever
  • RUQ tenderness
  • high WCC
  • positive Murphy’s sign
21
Q

List some of the complicationso of acute cholecystitis

Study These Flashcards
A
  • necrotising inflammation + risk of perforation
  • empyema (pus in gall bladder)
  • mucocoele
  • fistula formation + risk of gallstone ileus
  • adhesions
22
Q

A complication of acute cholecystitis is fistulas. What structures would the fistula form between and what is a possible consequence?

Study These Flashcards
A
  • fistula b/w gall bladder and stomach/duodenum

- gallstone ileus may occur (gall stone gets stuck in terminal ileum)

23
Q

List 3 consequences of a CBD obstruction by gall stones

Study These Flashcards
A
  1. Obstructive Jaundice
  2. Ascending Cholangitis
  3. Acute Pancreatitis
24
Q

What is chronic cholecystitis and what is it a/w?

Study These Flashcards
A
  • always a/w gall stones

- gall bladder shows chronic response to repeated obstruction/inflammation

25
Describe the appearance of chronic cholecystitis
- fibrotic, shrunken gall bladder w/ stones - thickened muscle - atrophied mucosa - diverticula
26
What are the possible treatments for gall stones?
Symptomatic - remove (cholecystectomy) Asymptomatic - observe
27
What is an MRCP?
- non-invasive | - MRI scan of the liver, gallbladder, bile ducts, pancreas and pancreatic duct
28
How would an extrahepatic bile duct obstruction appear on ultrasound?
there will be dilated ducts above the obstruction
29
If there are gallstones causing an extrahepatic bile duct obstruction, what would be the treatment?
ERCP w/ sphincterotomy ± stone removal
30
If there is a stricture causing an extrahepatic bile duct obstruction, what would be the treatment?
stent
31
If there is a tumour causing an extrahepatic bile duct obstruction, what would be the treatment?
stent
32
What is ascending cholangitis a complication of?
blockage of a bile duct (esp. CBD)
33
What is Charcot's Triad?
a/w biliary obstruction and ascending cholangitis 1. High Fever 2. Pain 3. Jaundice
34
What is Reynold's Pentad?
a/w biliary obstruction and ascending cholangitis 1. High Fever 2. Pain 3. Jaundice 4. Hypotension 5. Altered Mental State
35
What is the treatment/management plan for ascending cholangitis?
- IV antibiotics - IV fluids - urgent decompression of bile duct (removal of bile and the underlying cause of the blockage)
36
What is the most common cause of a hepatic abscess?
biliary tract disease a/w ascending infection
37
Is mild or severe pancreatitis more common?
Mild Pancreatitis
38
Why may there be hypocalcaemia with acute pancreatitis?
- fat that gets damaged attracts calcium - these create calcium soaps (saponification) - fat necrosis occurs
39
What is the treatment for acute pancreatitis caused by gall stones?
- urgent ERCP and sphincterotomy | - laparoscopic cholecystectomy when it resolves (if needed)
40
What is a positive murphy's sign suggestive of?
Acute Cholecystitis
41
What are the histological features of chronic pancreatitis?
- patchy, irreversible fibrosis* - ongoing inflammation - exocrine > endocrine pancreas - strictures - dilatation + cysts behind strictures*
42
List some causes of chronic pancreatitis
- chronic alcohol use - childhood causes (e.g CF) - --- CF more typically a/w pancreatic insufficiency - idiopathic
43
List some of the symptoms of chronic pancreatitis
- pain (dull, epigastric, radiating to back) - weight loss - steatorrhoea (fat in the stool) - malabsorption (b/c there is a deficiency of fat-soluble vitamins, ADEK)
44
List the treatments for chronic pancreatitis
- analgesia | - enzyme supplements
45
What is a pancreatic pseudocyst and what are some of the causes?
- collection of pancreatic fluid in disrupted tissue - not a true cyst Causes: - acute/chronic pancreatitis - pancreatic surgery - trauma
46
What is another term for surgical jaundice?
obstructive jaundice
47
What is the most common cause of obstructive jaundice (surgical jaundice)?
GALL STONES (an extrahepatic bile duct obstruction)
48
List some indications for laparoscopic cholecystectomy
- symptomatic cholelithiasis (stones in gallbladder) - cholecystitis - porcelain gallbladder

GIHEP (24 decks)

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