Thandie mOyo Biliary tract disease
Tutorial 1
Mr Mayowa Ojofeitimi
Learning objectives
1. Describe and outline how to make a diagnosis of biliary colic in a patient with undifferentiated abdominal pain. 2. Describe the management of pain in accordance with the WHO pain ladder. 3. Describe the clinical features of acute cholecystitis and expected investigation results. 4. Describe the risk factors for gall stone disease and commonly affect demographic. 5. Describe the causative organisms for acute cholecystitis and their source and select appropriate antibiotics.
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed.
7. Describe the diagnostic criteria for biliary tract obstruction and the multiple causes of biliary tract obstruction.
8. Describe the association of diet and lifestyle with gallstone disease.
9. Describe the process of bile formation and the bile cycle.
10.Differentiate non-obstructive jaundice and obstructive jaundice. Describe causes of non-obstructive jaundice.
Initial presentation
Miss Thandie Moyo is a 42 year old female, brought to ambulance with severe abdominal pain. She is with her brother and next of kin, Richard. This pain has been intermittent and present for the previous 2 weeks; however, the pain is now unbearable.
Pain management
In medicine, managing acute pain is a critical, immediate priority. Whether it's a medical or surgical issue, pain must be relieved as soon as possible.
A common misconception is that giving pain relief, or analgesia, might hide the diagnosis. However, guidelines like the St George’s Grey Book emphasize that this is extremely rare. The standard of care is to investigate and treat the underlying cause simultaneously with managing the patient's pain.
It's also vital to set realistic expectations. We generally classify pain as mild, moderate, or severe. While we always aim to reduce suffering, the primary goal is usually to achieve comfort rather than the complete abolition of all pain.
To do this safely and effectively, we follow a globally recognized framework: the WHO Analgesic Ladder. Step 1 is for mild pain. This is managed with regular, simple analgesics. These are non-opioid medications like paracetamol and/or an NSAID (a non-steroidal anti-inflammatory drug), such as Ibuprofen, provided the patient has no contraindications.
If the patient's pain persists or is classified as moderate pain, we move to Step 2. At this stage, we add a weak opioid (like codeine or tramadol) to the Step 1 analgesia. We don't replace the paracetamol or NSAID; we use them in combination.
If the pain is still uncontrolled, or if the patient presents with severe pain from the start, we move to Step 3. Here, we change the weak opioid to a strong oral opioid, such as morphine. Critically, we continue the Step 1 analgesics (the paracetamol or NSAID) because they work on different pain pathways and enhance the overall effect.
So, in a clinical scenario involving severe pain, a common, correct option following the Step 3 guideline would be to administer 10mg of oral morphine stat.
PAIN mANAGEMENT
LO: Describe the management of pain in accordance with the WHO pain ladder.
Physical examination
Inspection:
Lying on the bed. Looks reasonably comfortable following oramorph. High BMI. No walking aids.
Hands: Normal - no signs
Face: No pallor or jaundice. No eye signs. Dry mucous membranes.
Abdomen: Not distended. No scars visible. No skin changes. No caput medusae.
Legs: No swelling or erythema.
Palpation:
Abdomen: Soft. Mild right upper quadrant tenderness. No rebound tenderness.
No hepatomegaly. No splenomegaly. Non ballotable kidneys. Normal aortic pulse. Murphy’s sign negative. Rovsing’s sign negative.
Legs: Both legs are non-tender, no peripheral oedema.
Auscultation:
CVS: Pulse 108, regular rhythm. HS 1+2, no added sounds.
Chest: Vesicular breath sounds throughout both lungs. No basal crackles.
Abdomen: Normal bowel sounds. No renal bruits
Differential diagnoses
50%
of our brain is involved in the processing of visual stimuli.
80%
of what we do and see,we remember
85%
purchases are emotional
LO: 1. Describe and outline how to make a diagnosis of biliary colic in a patient with undifferentiated abdominal pain.
1. Describe and outline how to make a diagnosis of biliary colic in a patient with undifferentiated abdominal pain.
4. Describe the risk factors for gall stone disease and commonly affect demographic.
3. Describe the clinical features of acute cholecystitis and expected investigation results. 5. Describe the causative organisms for acute cholecystitis and their source and select appropriate antibiotics.
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed.
8. Describe the association of diet and lifestyle with gallstone disease.
9. Describe the process of bile formation and the bile cycle.
Use an image
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed.
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed.
7. Describe the diagnostic criteria for biliary tract obstruction and the multiple causes of biliary tract obstruction.
8. Describe the association of diet and lifestyle with gallstone disease.
9. Describe the process of bile formation and the bile cycle.
10.Differentiate non-obstructive jaundice and obstructive jaundice. Describe causes of non-obstructive jaundice.
Use an image
Here you can include a relevant data point to highlight
Here you can include a relevant data point to highlight
Here you can include a relevant data point to highlight
Do you need more reasons to create dynamic content? Well: 90% of the information we absorb comes through sight, and we retain 42% more information when the contentis moving.
NCEPOD
The NCEPOD classification
Immediate (category 1) – when immediate, life, limb, or organ-saving intervention is required. The target time to the operating room is within minutes of the decision to operate.
Urgent (category 2) - urgent procedures involve acute onset or deterioration of conditions that threaten life, limb, or organ survival; fixation of fractures; or relief of distressing symptoms. The target time to the operating room is usually within hours of the decision to operate.
Expedited (category 3) - expedited procedures are for stable patients requiring early intervention for a condition that is not an immediate threat to life, limb, or organ survival. The target time to the operating room is usually within days of the decision to operate.
Elective (category 4) - this includes surgical procedures planned or booked in advance of routine hospital admission. The timing of the procedure is flexible and can be arranged to suit the patient, hospital, and staff.
Heart Rate (HR):106 bpm (Normal range: 60-100 bpm) Rythm- This indicates sinus tachycardia.Oxygen Saturation (SpO2): 98% (Normal range: 95-100%)
Systolic Blood Pressure (SYS): 128 mmHg (Normal range: 90-120 mmHg)
Diastolic Blood Pressure (DIA):74 mmHg (Normal range: 60-80 mmHg)
Thandie mOyo Biliary tract disease
Brian Ojofeitimi
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Transcript
Thandie mOyo Biliary tract disease
Tutorial 1
Mr Mayowa Ojofeitimi
Learning objectives
1. Describe and outline how to make a diagnosis of biliary colic in a patient with undifferentiated abdominal pain. 2. Describe the management of pain in accordance with the WHO pain ladder. 3. Describe the clinical features of acute cholecystitis and expected investigation results. 4. Describe the risk factors for gall stone disease and commonly affect demographic. 5. Describe the causative organisms for acute cholecystitis and their source and select appropriate antibiotics. 6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed. 7. Describe the diagnostic criteria for biliary tract obstruction and the multiple causes of biliary tract obstruction. 8. Describe the association of diet and lifestyle with gallstone disease. 9. Describe the process of bile formation and the bile cycle. 10.Differentiate non-obstructive jaundice and obstructive jaundice. Describe causes of non-obstructive jaundice.
Initial presentation
Miss Thandie Moyo is a 42 year old female, brought to ambulance with severe abdominal pain. She is with her brother and next of kin, Richard. This pain has been intermittent and present for the previous 2 weeks; however, the pain is now unbearable.
Pain management
In medicine, managing acute pain is a critical, immediate priority. Whether it's a medical or surgical issue, pain must be relieved as soon as possible. A common misconception is that giving pain relief, or analgesia, might hide the diagnosis. However, guidelines like the St George’s Grey Book emphasize that this is extremely rare. The standard of care is to investigate and treat the underlying cause simultaneously with managing the patient's pain. It's also vital to set realistic expectations. We generally classify pain as mild, moderate, or severe. While we always aim to reduce suffering, the primary goal is usually to achieve comfort rather than the complete abolition of all pain. To do this safely and effectively, we follow a globally recognized framework: the WHO Analgesic Ladder. Step 1 is for mild pain. This is managed with regular, simple analgesics. These are non-opioid medications like paracetamol and/or an NSAID (a non-steroidal anti-inflammatory drug), such as Ibuprofen, provided the patient has no contraindications. If the patient's pain persists or is classified as moderate pain, we move to Step 2. At this stage, we add a weak opioid (like codeine or tramadol) to the Step 1 analgesia. We don't replace the paracetamol or NSAID; we use them in combination. If the pain is still uncontrolled, or if the patient presents with severe pain from the start, we move to Step 3. Here, we change the weak opioid to a strong oral opioid, such as morphine. Critically, we continue the Step 1 analgesics (the paracetamol or NSAID) because they work on different pain pathways and enhance the overall effect. So, in a clinical scenario involving severe pain, a common, correct option following the Step 3 guideline would be to administer 10mg of oral morphine stat.
PAIN mANAGEMENT
LO: Describe the management of pain in accordance with the WHO pain ladder.
Physical examination
Inspection: Lying on the bed. Looks reasonably comfortable following oramorph. High BMI. No walking aids. Hands: Normal - no signs Face: No pallor or jaundice. No eye signs. Dry mucous membranes. Abdomen: Not distended. No scars visible. No skin changes. No caput medusae. Legs: No swelling or erythema. Palpation: Abdomen: Soft. Mild right upper quadrant tenderness. No rebound tenderness. No hepatomegaly. No splenomegaly. Non ballotable kidneys. Normal aortic pulse. Murphy’s sign negative. Rovsing’s sign negative. Legs: Both legs are non-tender, no peripheral oedema. Auscultation: CVS: Pulse 108, regular rhythm. HS 1+2, no added sounds. Chest: Vesicular breath sounds throughout both lungs. No basal crackles. Abdomen: Normal bowel sounds. No renal bruits
Differential diagnoses
50%
of our brain is involved in the processing of visual stimuli.
80%
of what we do and see,we remember
85%
purchases are emotional
LO: 1. Describe and outline how to make a diagnosis of biliary colic in a patient with undifferentiated abdominal pain.
1. Describe and outline how to make a diagnosis of biliary colic in a patient with undifferentiated abdominal pain.
4. Describe the risk factors for gall stone disease and commonly affect demographic.
3. Describe the clinical features of acute cholecystitis and expected investigation results. 5. Describe the causative organisms for acute cholecystitis and their source and select appropriate antibiotics.
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed.
8. Describe the association of diet and lifestyle with gallstone disease.
9. Describe the process of bile formation and the bile cycle.
Use an image
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed.
6. Describe the anatomy of the biliary tree and draw a labelled diagram. Outline points at which it may become obstructed. 7. Describe the diagnostic criteria for biliary tract obstruction and the multiple causes of biliary tract obstruction. 8. Describe the association of diet and lifestyle with gallstone disease. 9. Describe the process of bile formation and the bile cycle. 10.Differentiate non-obstructive jaundice and obstructive jaundice. Describe causes of non-obstructive jaundice.
Use an image
Here you can include a relevant data point to highlight
Here you can include a relevant data point to highlight
Here you can include a relevant data point to highlight
Do you need more reasons to create dynamic content? Well: 90% of the information we absorb comes through sight, and we retain 42% more information when the contentis moving.
NCEPOD
The NCEPOD classification Immediate (category 1) – when immediate, life, limb, or organ-saving intervention is required. The target time to the operating room is within minutes of the decision to operate. Urgent (category 2) - urgent procedures involve acute onset or deterioration of conditions that threaten life, limb, or organ survival; fixation of fractures; or relief of distressing symptoms. The target time to the operating room is usually within hours of the decision to operate. Expedited (category 3) - expedited procedures are for stable patients requiring early intervention for a condition that is not an immediate threat to life, limb, or organ survival. The target time to the operating room is usually within days of the decision to operate. Elective (category 4) - this includes surgical procedures planned or booked in advance of routine hospital admission. The timing of the procedure is flexible and can be arranged to suit the patient, hospital, and staff.
Heart Rate (HR):106 bpm (Normal range: 60-100 bpm) Rythm- This indicates sinus tachycardia.Oxygen Saturation (SpO2): 98% (Normal range: 95-100%) Systolic Blood Pressure (SYS): 128 mmHg (Normal range: 90-120 mmHg) Diastolic Blood Pressure (DIA):74 mmHg (Normal range: 60-80 mmHg)