Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
“Cholelithiasis” means |
the presence of gallstones |
|
|
about ___% of adults and ___% of people > 65 yr have gallstones. |
about 10% of adults and 20% of people > 65 yr have gallstones. |
|
|
main risk factors for cholelithiasis |
female, fertile, fat and forty |
|
|
other risk factors for cholelithiasis |
* pregnancy * diet high in saturated fats * diabetes mellitus * ileal disease/resection (disrupts bile salt resorption) * haemolytic states (which cause ‘pigment’ gallstones) rapid weight loss * medications – estrogen and oral contraceptives, ceftriaxone, octreotide |
|
|
gallstones in the CBD |
Choledocholithiasis |
|
|
bile duct inflammation |
Cholangitis |
|
|
Cholecystitis |
impaction in the neck of the gallbladder or cystic duct |
|
|
Radiation and alleviation of biliary colic pain |
radiates to back - tip of R. scapula alleviated by movement, worse on lying still |
|
|
two common key symptoms of any gut problem to always consider, and one serious one. |
nausea + vomiting serious: fever (?sepsis) |
|
|
Acute cholecystitis is caused by |
obstruction of gallbladder emptying |
|
|
What % of acute cholecystitis cases are caused by stones |
95% |
|
|
What is Cullen's sign in acute cholecystitis |
Trick question: Cullen's sign is for acute pancreatitis (haemorrhagic discoloration of the umbilicus) The other sign in acute pancreatitis is Grey Turner's (haemorrhagic discoloration of the flanks) |
|
|
Complications of acute cholecystitis |
perforation -> sepsis gangrenous cholecystitis |
|
|
Investigations for cholecystitis |
* Ultrasound: will show a thick-walled gallbladder and pericholecystic fluid. 90% of gallstones are seen on ultrasound.
* FBC: Moderate leukocytosis and raised inflammatory markers, picture of haemolytic anaemias underlying. LFTs: obstructive jaundice pattern. |
|
|
Treatment for acute cholecystitis |
Cholecystectomy |
|
|
Plain X-ray of the abdomen shows ___% of gallstones. |
Plain X-ray of the abdomen shows only 10% of gallstones. |
|
|
What is Charcot's triad and what condition does it relate to? |
Charcot's triad = biliary colic, fever, jaundice Relates to cholangitis |
|
|
What's two anatomical features are where the pancreatic duct meets the duodenum? |
Ampula of Vater Sphincter of Oddi |
|
|
Investigations for choledocholithiasis & cholangitis |
LFTs (backward liver damage due to block) Amylase (pancreatitis) Prothrombin time (vit K is fat soluble) Ultrasound (stones + possible dilatation of intrahepatic ducts) |
|
|
cholangitis = |
inflammation of the common bile duct |
|
|
cholangitis infection treated by ___ and why |
ciprofloxacin (penetrates well into bile) |
|
|
patchy inflammation, fibrosis, and strictures of the bile ducts (intra- and extra-hepatic) that has no known cause |
Primary sclerosing cholangitis (PSC) |
|
|
Primary sclerosing cholangitis presentation |
presents as a progressive obstructive jaundice often accompanied by fatigue, pruritis, anorexia, steatorrhea and deficiencies of fat-soluble vitamins |
|
|
Progression and terminal phase of primary sclerosing cholangitis |
PSC tends to slowly and inexorably progress. The terminal phase involves decompensated cirrhosis, portal hypertension, ascites, and liver failure |
|
|
Tx for cholangitis |
* Localized strictures can be dilated with the use of a balloon, and short-term stents may be placed in major strictures to relieve symptoms
* No procedures reduce the risk of cholangiocarcinoma.
* Once cirrhosis occurs, liver transplantation is the procedure of choice. |
|
|
Tx for primary cancer of the gallbladder |
* Resection of an early lesion may be curative.
* Once lymphatic spread has occurred treatment will no longer be curative. Chemotherapy is not effective and radiotherapy is only effective for a small proportion. |
|
|
When is a gallbladder polyp said to have malignant potential |
when it's over 1cm |
|
|
What's bile duct cancer called? |
cholangiocarcinoma |
|
|
What type of cholangiocarcinoma is harder to treat? |
Cancer of intrahepatic bile ducts Extrahepatic ducts like CBD can be resected |
|
|
Tx for cholangiocarcinoma |
Most is palliative. Response to radio/chemo poor. Stents possible to relieve obstruction. |
|
|
What is Courvoisier's law? |
In the presence of an enlarged gallbladder which is nontender and accompanied with mild jaundice, the cause is unlikely to be gallstones.
Rather carcinoma of the pancreas or the lower biliary tree is more likely.
This may be explained by the observation that the gallbladder with stones is usually chronically fibrosed and so, incapable of enlargement. |
