Week 109 Renal Colic & Haematuria Flashcards
(48 cards)
What is bilirubin?
By-Product of red blood cell breakdown.
- Conjugated in liver - allows excretion with bile in small duodenum
- Enzymes in terminal ileum deconjugate
- A small portion is reduced to urobilinogen (in stool) & Kidneys
- Rest reabsorbed @ terminal ileum
What is Cholethiasis?
The presence of gallstones in the gallbladder.
What does bile consist of?
Water
Bile Acids - synthesised from cholesterol
Cholesterol
Bilirubin
What is choledocholithiasis?
A clinical scenario whereupon the gallstone passes into the cystic or common bile ducts.
What is a cholecystectomy?
Gall bladder removal.
What is cholangitis?
Of or referring to an infection of the common bile duct.
Name of two major facets of clinical manifestations of gallstone disease.
Biliary colic and cholecystitis
What is murphys sign?
- 2 fingers on Right hypochondrium & ask to breathe in
- Results in pain & arrest of respiration as the gallbladder moves below the costal margin.
- CHECK BOTH SIDES. Only +ve if NOT ON THE LEFT SIDE.
A patient has recurrent abdo pain, jaundice, pale stools & dark urine.
Cholelithiasis
Cholelocholithiasis
Cholecystitis
Investigations for suspected biliary tract infection.
FBC - Neutrophilia if acute cholecystitis present
LFT - High bilirubin & alkaline phosphatase (obstructive jaundice)
Amylase –> Mild raise in biliary colic but used to exclude pancreatitis.
Ultrasound/Radioisotope scan/ercp/mri/cholangiography
What is the diameter of the common bile duct?
<8mm in a patient following cholecystectomy
What are the complications of cholecystitis?
- Acute pancreatitis
- Ascending cholangitis
- Gallstones ileus
- Carcinoma of gall bladder
What is a cholangiocarcinoma?
Adenocarcinoma of bile ducts associated with dense fibrous tissue.
Intra or extra hepatic
Uncommon - 8-10% of primary liver tumours.
Treatment of acute cholecystitis?
Asymptomatic - no treatment
Infection suspected: - Analgesia, anti-emetics, IV fluids, Blood cultures and antibiotics
Cholecystectomy, open laparoscopic. ERCP if choledocholithiasis.
A patient presents with jaundice. Which four sites for tumours involving the bile duct may present with jundice?
CHOLANGIOCARCINOMA - HILUM OR BELOW
CYSTIC DUCT OR GALL BLADDER
PANCREATIC DUCT
AMPULLARY TUMOUR
What is cholangitis?
A common (potentially serious) infection of the bile duct. A complication of bile stasis.
Symptoms of cholangitis?
Fever
jaundice
Right upper quadrant pain
What investigations would you conduct for a patient with cholangitis (bile duct infection)?
LFT - < Alkaline phosphatase & bilirubin
FBC - < neutrophilia
CRP - < Infection
BLOOD CULTURES - +VE IN OVER 90% - USUALLY G-VE E.COLI
HOW IS BILIRUBIN METABOLISED?
MACROPHAGES ENGULF RED BLOOD CELLS = HAEM&GLOBIN
IRON FROM HAEM GROUP –> BILIVERDIN –> BILIRUBIN (BOUND TO ALBUMIN IN BLOOD PLASMA)
HOW IS BILIRUBIN EXCRETED?
BILIRUBIN IS CONJUGATED IN THE LIVER
HEADS TO THE SMALL INTESTINE –> UROBILINOGEN
EXCRETED IN FAECES, RECYCLE (LIVER) URINE.
WHAT IS INDICATED BY BROWN OR TEAC COLOURED URINE?
HIGH BILIRUBIN
WHAT IS INDICATED BY PINK URINE?
LAXATIVES
BEETROOT
WHAT IS INDICATED BY RED URINE?
BLOOD
WHAT IS INDICATED BY BLACK URINE?
BROKENDOWN HAEMOGLOBIN
