Gall bladder and such

Question 1

What are the signs of cholestasis?

Answer 1

• Jaundice
• itching
• RUQ intermittent pain
• acute or chronic
• ?painless
• dark brown urine
• pale/white stool
• weight loss
• lethargy

Question 2

What bloods tests do you do for cholestasis Sx?

Answer 2

-bloods:
LFTs - high bilirubin
-alk phos - most important for gall bladder disease (choleliathsis not cyctisis)
-ALT will go up 
-GGT- not specific

Question 3

What does an isolated bilirubin w/o signs?

Answer 3

-gilberts syndrome - autosomal dominant abnomrality in bilirubin metabolism

Question 4

Why do gallstones form?

Answer 4

stasis of bile that has a high amount of cholestrol in.

Cholestrol causes precipitation of stones. Or pigment stones caused by increase turn over of RBC, haemolysis.

Question 5

What Sx do gall stones cause?

Answer 5

• Epigastric pain to RUQ
• RUQ pain radiates to the R shoulder/scapula
• COLIC - 30 mins to 5 hrs - comes and goes
• post prandial pain (after eating because GB is preparing to squeeze out bile for digestion)
• nocturnal pain

Question 6

what’s the symptomatic and examination difference between normal gallstones and cholecystitis?

Answer 6

• may have signs of sepsis
• biliary pain is progressive
• Hx of previous gall stones
• Murphy’s sign positive in cholecystisis

Question 7

What would you find on tests for a patient with cholecytsitis?

Answer 7

• increased WBC count
• increased CRP
• USS - thick inflamed GB
• MRCP - better visualise the CBD

Question 8

DDx for acute cholecystitis.

Answer 8

• Pancreatitis
• Appendicitis
• peptic ulcer disease
• liver abscess
• pneumonia
• ?MI
• perforated bowel

Question 9

How does cholangitis differ from cholecystitis?

Answer 9

Cholangitis is an ascending infection of the CBD.

Occurs due to a blockage of the CBD and can happen without a gall bladder.

Question 10

What are the symptoms of Ascending cholangitis?

Answer 10

-painful jaundice
-Charcots triad:
Fever, Jaundice and RUQ pain. (obstructive jaundice)
-Can progress to Renold’s pentad:
charcot’s triad + hypotension + atlered mental status

Question 11

how do you treat ascending cholangitis?

Answer 11

• ERCP

- Abx - Co-amoxiclav

Question 12

What is primary sclerosing cholangitis?

Answer 12

• autoimmune inflammation of all the bile ducts
• 80% have ulcerative colitis too
• yearly colonoscopy because high risk bowel Ca

Question 13

presentation of PSC?

Answer 13

• fatigue
• pruritis
• anorexia
• indegestion
• jaundice = late complication

Question 14

Bloods for PSC?

Answer 14

• alk phos = sustained rise
• autoantibodies - +ve P-ANCA or +ve ANA
• test for IgM too

Question 15

Tx for PSC?

Answer 15

• ultimately liver transplant - when starts sclerosing and before Ca because not fit for transplant then
• ?ciprofloxacin acute bacterial infection
• ursodeoxycholic acid
• anti-puritics

Question 16

What’s the similarities and differences between primary billary cholangitis (PBC) and primary sclerosing cholangitis (PSC)?

Answer 16

They’re both autoimmune disorders.

• Primary Billary Cholangitis (B IS NOT FOR BOIS OR BODIES) is more common in middle aged women and is associated with hashimoto’s, grave’s, RA,
• Primary Sclerosing Cholangitis is more associated with younger men and is associated with UC

Question 17

How do you treat primary billary cholangitis?

Answer 17

• ursodeoxycholic acid
• anti-puritic - anti-histamines
• liver transplant is curative