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Biliary Colic Pain (pain due to GALL STONES, site: epigastrium/right…
Biliary Colic Pain
pain due to GALL STONES
site: epigastrium/right hypochondrium
onset: rapidly increasing
character: constant
radiation: below right scapula
ass sym: non-spec
timing: many attacks, unpredictable, 4-24h
exacerbating factors: eating - unable to
severity: severe
cystic duct obstruction
Gall Stones
Complications
acute cholecystitis
obstruction of gall bladder emptying by stone in neck
continuous epi/RUQ pain, vom, fever, local peritonism or GM mass, tenderness, guarding
inflammatory component (unlike colic)
Murphy's sign +ve
pain relief, IVI, Ab
cholangitis
infection of bile duct
RUQ pain, jaundice, fever (often w rigors)
IV Ab
chronic cholecystitis
chronic inflam + colic
flatulent dyspepsia, abdo discomfort, distension, nausea, flatulence, fat intolerance
cholecystectomy
choledocholithias
gall stone in common bile duct
empyema
obstructed GB fills with mucus/pus
acute pancreatitis
inflam of pancreatic gland
other causes
G
all stones
E
thanol
T
rauma
S
teroids
M
umps
A
utoimmune
S
corpion venom
H
yperlipidaemia, hypothermia, hypercalcaemia
E
RCP, emboli
D
rugs
sudden, constant pain, radiating into back, worse after heavy drinking, >24h, worse with alcohol, eating, relieved by sitting upright, severe
grey-turner sign (bruising of flanks)
cullen's sign (around umbilicus)
clinical features
nausea and vomiting
fevers and rigor
majority asym
jaundice
treatment
ERCP
risk factors
female, fat, fourties, fair
produced by gall bladder, contain cholesterol, bile pigments and phospholipids
nb chronic pancreatitis causes steatorrhoea