8. Gallstones

Question 1

How common is it?

Answer 1

Very common (1 in 10) but only a minority of these develop symptoms

Question 2

Who does it affect?

Answer 2

Women >40 typically

Less common amongst African and Asian pts

Question 3

What causes it?

Answer 3

Hardened deposits of bile form as a result of i) high cholesterol concentration (from the diet) ii) high bilirubin concentration (from RBC breakdown)

Question 4

What risk factors are there?

Answer 4

Female, overweight, >40 y/o
Patients with cirrhosis, PSC, IBS, Crohn’s
Family history, recent weight loss
Haemolytic conditions (pigment stones)

Question 5

How does it present?

Answer 5

Asymptomatic unless they block the bile duct

Jaundice, biliary colic, pyrexia

Question 6

What signs may the patient have on examination?

Answer 6

Yellow sclera
Murphy’s sign, guarding
Pain may radiate to back

Question 7

What other conditions may present similarly?

Answer 7

Hepatitis, GORD, IBD, IBS, peptic ulcer, gastritis, gallbladder polyps

Question 8

How would you investigate?

Answer 8

Ultrasound, MRI, cholangiography

Question 9

What treatments are there?

Answer 9

Laparoscopic cholecystectomy, ERCP
Ursodeoxycholic acid (T 1+2)
Low-fat diet

Question 10

What complications are there?

Answer 10

Obstructive jaundice, acute cholangitis, acute pancreatitis

Cirrhosis, portal hypertension