Gallbladder Pathway - Biliary Code Suspected
Biliary Tract Disease includes:
- Biliary colic
- Occurs when a gallstone obstructs the cystic duct.
- Pain is usually severe, dull, boring, constant, 1-5hrs duration, starting 30 minutes to hours after a meal, often at night waking the patient and in the epigastrium or RUQ. May radiate to right scapula or back.
- Nausea and vomiting often occur.
- Patients tend to move around to seek pain relief.
- On abdominal examination the patient has epigastric or RUQ abdominal tenderness and guarding. There are no signs of peritonitis.
- The patient is not jaundiced and vital signs are usually normal.
- Patients who present with biliary colic may be candidates for Direct Access Gallbladder Surgery.
- Occurs when gallstone obstruction of the cystic duct is prolonged (>6hrs). There is initially a chemical inflammation and then a superimposed bacterial infection of the gallbladder.
- The pain is like that felt with biliary colic but lasting > 24hrs.
- Patients tend to lie still as movement aggravates the pain.
- On abdominal examination the patient has epigastric or RUQ abdominal tenderness and guarding and 97% have a positive Murphy sign.
- Jaundice occurs in < 20% but may occur if the stone in the cystic duct compresses the common bile duct. Choledocholithiasis must be excluded if the patient is jaundiced.
- The patient's vital signs may become abnormal with fever and tachycardia.
- Cholecystitis is referred to the Surgical Registrar on call as an emergency.
- Choledocholithiasis and Cholangitis
- Occurs when a gallstone passes into the common bile duct.
- The pain is similar to biliary colic and cholecystitis.
- Cholangitis is more often associated with fever, jaundice, nausea and vomiting.
- The patient is unwell with jaundice, fever or rigors, tachycardia and may be hypotensive with a reduced level of consciousness - this is a surgical emergency.
- The abdominal examination findings are similar to those of cholecystitis.
- Rigors, RUQ abdominal pain and jaundice (the Charcot triad) is highly suggestive of cholangitis.
- Cholangitis is referred to the Surgical Registrar on call as an emergency.
- Asymptomatic gallstones
- Smaller stones more likely to be symptomatic than large stones.
- Indigestion, belching, bloating and fatty food intolerance may occur but are often not cured by cholecystectomy.
- Only 2-3% of patients with asymptomatic gallstones will develop symptoms each year.
- Refer asymptomatic gallstones to the General Surgical Outpatient clinic when:
- Patient is immunocompromised, is waiting for organ transplantation or has Sickle Cell Disease.
- Calcified (porcelain) gallbladder.
- Gallbladder polyp > 10mm in size or showing rapid growth in size.
- Gallbladder trauma.
- Patients develop symptoms.
Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016
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