Biliary Disease: Definitions

00:01 Now, let’s take a few moments to talk about definitions here.

00:05 This is something when I was a student that would confuse me all the time.

00:08 So I wanna make sure that we’re all on the same page before we get started talking about more complex material.

00:14 So Cholelithiasis, what does that mean? Cholelithiasis means that there are gallstones in the gallbladder.

00:21 It doesn’t say anything about whether or not the patient has an infection or anything along those lines.

00:27 It just means that there’s gallstones there.

00:29 Patients can have gallstones and actually not be symptomatic with them.

00:32 But all that means is that there are gallstones there.

00:35 So if you get an ultrasound report that says cholelithiasis, just means there's gallstones.

00:40 Cholecystitis is the next definition to review.

00:44 So a cholecystitis means, is it means that there is inflammation and infection of the gall bladder.

00:50 So this is when we get into the infection component.

00:53 So Cholelithiasis, just stones; cholecystitis is inflammation and infection.

00:59 Cholangitis is the next definition.

01:03 So what cholangitis means, is it means that there’s obstruction of the ductal system in the liver.

01:08 This leads to elevated pressures and infection.

01:12 The classic triad here we’ll talk about in a moment, but fever, right upper quadrant pain, and jaundice.

01:18 So what are the common presenting complaints? What do people come to the Emergency Department complaining of? Right upper quadrant abdominal pain is a very common chief complain here.

01:30 And this is one of those pains that can radiate actually to the right scapula or the right shoulder, so the right posterior upper back or the right shoulder.

01:40 Patients oftentimes will have nausea and vomiting.

01:44 The pain may be worse after eating.

01:47 This is one of those situations where it’s very helpful to ask about factors that provoke the pain and factors that make the pain potentially better.

01:55 So especially after eating fatty foods.

01:57 So you eat french fries and a burger, or something along those lines.

02:01 And the pain gets worst in that area, that definitely supports the fact that there may be gallstones or possibly even cholecystitis.

02:08 Fever mostly present in a situation of cholecystitis, so if there’s that inflammation and infection there that’s when the fever component would happen.

02:16 And then yellowing of the skin or the eyes which means jaundice essentially.

02:22 So you wanna make sure you’re looking in the eyes, looking at the skin closely, sometimes it can be hard to see.

02:27 Jaundice especially in patients who have darker skin tones, but asking patients sometimes if they look different than they look normally can help you there.

02:35 Sometimes I ask patients to see their license if they described that they look different or they feel like they look different so you can compare a little bit, what they look like on a regular day to what they look like today.

02:45 And this is mainly something that occurs when patients have that cholangitis component.

02:52 So when they have the blockages of the vessels of the ductal system within their liver.

02:56 What are we gonna see on our physical exam here? Pain, tenderness in the right upper quadrant and also a Murphy’s sign.

03:04 So what is a Murphy’s sign mean? A Murphy’s sign is when you palpate in the right upper quadrant and when you are palpating deeply the patient stops their inspiratory effort.

03:15 And that’s associated with pain.

03:17 Other things to look for are jaundice or scleral icterus.

03:22 Scleral icterus is yellowing of the conjunctiva of the eyes.

03:26 You wanna make sure you're reviewing those vital signs.

03:29 You're looking for fever, patients potentially who are very sick may have evidence of sepsis and those patients would have a low blood pressure or an elevated heart rate.

03:39 Definitely you are looking for the fever in that area as well.

03:43 Now, Charcot’s Triad is something that supports the diagnosis of cholangitis.

03:49 So the triad consists of fever, plus right upper quadrant pain plus jaundice equals Charcot’s Triad.

03:57 You can also add in hypotension and altered mental status.

04:01 If you add those in it equals Reynold’s Pentad.

04:05 Cholangitis is one of those diagnoses that you wanna be sure not to miss.

04:09 Patients can be very, very ill when they have cholangitis.

04:13 So if you're worried about this diagnosis definitely be thinking about this triad as well as the Pentad.