11. Gallstone disease (symptoms, diagnosis, treatment, complications)

Question 1

Triangle of Calot

Answer 1

Borders: cystic duct, common hepatic duct, liver

Cystic artery sneaks through

Question 2

Gallstones

Answer 2

• Cholesterol stones – 80%

- Pigment stones – Ca bilirubinate or bacterial infection

Question 3

Gall bladder examinations

Answer 3

• US ( >90% specificity and sensitivity) – gold standard!
• MRCP (95% sensitivity and 89% specificity)
• Blood tests: WBC, LFT (ASAT, ALAT, GGT, ALP)
• CT – malignancy
• ERCP – therapeutic intervention (NB! Complications include pancreatitis and choleangitis)
• PTC/PTD

Question 4

Signs and symptoms

Answer 4

• RUQ pain
• Nausea
• Vomiting
• Extrahepatic cholestasis signs (jaundice, pale stools)

Question 5

Surgeries

Answer 5

• Open and closed cholecystectomy

Question 6

Contraindications of surgery

Answer 6

• Relative: Bowel obstruction, coagulation disorders, liver cirrhosis
• Absolute: patients who can’t tolerate general anesthesia

Question 7

Indications of surgery

Answer 7

• relative: Prophylactic in elderly with DM, increased cancer risk

Absolute:
- Porcelain gall bladder

• 2 or more occasions of pain/sludge
• Biliary dyskinesis
• Symptomatic gall bladder polyps
• Trauma

Question 8

Complications

Answer 8

Acute cholecystitis
Chronic cholecystitis
Choledocholithiasis 
Cholangitis
Pancreatitis

Question 9

Mirizzi’s syndrome

Answer 9

Impacted gall stone in duct causes inflammation and swelling of local tissue -> inflammation causing secondary obstruction in ducts