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31 Cards in this Set
- Front
- Back
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risk factors for cholesterol gallstones
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female, multiparity, obesity, rapid weight loss, diet (high animal fat)
drugs (contraceptive pill) ileal disease/resection diabets acromegaly liver cirrhosis |
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pigment stones occur in what conditions?
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seen in 40-60% with haemolysis
but majority of stones occur without haemolysis, likely bacterial colonisation producing glucuronidase and phospholipase |
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what two types of pigment stones?
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black (calcium bilirubinate mucin glycoproteins) and brown (calcium salts of fatty acids as well as calcium bilirubinate)
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what are brown stones associated with?
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bilary stasis/infection: PSC, caroli's syndrome, after cholecystectomy
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symptoms of bilary colic?
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severe constant epigastric/RUQ pain after fatty meal, most common evening hours/
crescendo, radiation into shoulder associated with nause/vomiting |
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What if bilary colic symptoms also with fever and rigors?
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complication: cholecystits, cholangitis or pancreatitis
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How are the symptoms of acute cholecystitis different from bilary colic?
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over hours localisation to RUQ with tenderness and guarding
empyema can develop, or gangraene with perforation and peritonitis. |
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Ultrasound findings of gallstones?
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galstone casting acoustic shadow, focal tendernes, thickened gallbladder wall
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AXR findings in gallstones?
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10% gallstones visible
calcifications of gallbladder wall gas in galbladder |
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DDx of gallstones (DDx RUQ pain)?
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perforated ulcer, pancreatitis, hepatic abscess, basal pneumonia, MI
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risk factors for cholesterol gallstones
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female, multiparity, obesity, rapid weight loss, diet (high animal fat)
drugs (contraceptive pill) ileal disease/resection diabets acromegaly liver cirrhosis |
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pigment stones occur in what conditions?
|
seen in 40-60% with haemolysis
but majority of stones occur without haemolysis, likely bacterial colonisation producing glucuronidase and phospholipase |
|
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what two types of pigment stones?
|
black (calcium bilirubinate mucin glycoproteins) and brown (calcium salts of fatty acids as well as calcium bilirubinate)
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what are brown stones associated with?
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bilary stasis/infection: PSC, caroli's syndrome, after cholecystectomy
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symptoms of bilary colic?
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severe constant epigastric/RUQ pain after fatty meal, most common evening hours/
crescendo, radiation into shoulder associated with nause/vomiting |
|
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What if bilary colic symptoms also with fever and rigors?
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complication: cholecystits, cholangitis or pancreatitis
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How are the symptoms of acute cholecystitis different from bilary colic?
|
over hours localisation to RUQ with tenderness and guarding
empyema can develop, or gangraene with perforation and peritonitis. |
|
|
Ultrasound findings of gallstones?
|
galstone casting acoustic shadow, focal tendernes, thickened gallbladder wall
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AXR findings in gallstones?
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10% gallstones visible
calcifications of gallbladder wall gas in galbladder |
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DDx of gallstones (DDx RUQ pain)?
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perforated ulcer, pancreatitis, hepatic abscess, basal pneumonia, MI
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When can extracorporal lithotrypsy be used?
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small number of stones, >10mm, intact gallbladder function.
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What is the post-cholecystectomy syndrome?
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pain like initial bilary colic months to years after
in a small minority, retained CBD stones or sphincter of Oddi hypertension can be cause of pain |
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biochemical profile in CBD stone?
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usually mildly elevated
if >200 suspect complete obstruction AST mildly elevated but very high in complete obstruction amylase mildly elevated, if very high ?pancreatitis PT - if high suspect complete obstruction and vit K absorption deficit |
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sensitivity of USS for CBD stones?
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excellent, except distal stones: 50%
presence of gallbladder stones poorly predictive as to the cause of obstruction |
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What is Mirizzi's syndrome?
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Compresson of CBD by a gallstone in cystic duct.
Rare cause of jaundice |
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What is Caroli's disease?
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rare inherited disease with dilation of intrahepatic bile ducts
caroli's syndrome: dilation of ducts, portal hypertension, congenital hepatic fibrosis |
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diagnosis of caroli's disease
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visulise ectasia: USS, spiral CT, MRCP...
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who is affected with caroli's?
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asian <22 usually
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management of acute cholangitis
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IV abx
urgent endoscopic bile duct drainage +/- stent if patient has gallbladder stones as well, lap choly with exploration of CBD and stone removal at the same time |
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clinical features of PSC?
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men at 40yr
episodic jaundice, pruritus or cholangitis 75% associated with ulcerative colitis elevated ALP |
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diagnosis of PSC
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pANCA positive 60%
MRCP/ERCP liver biopsy |
