Abdominal: Gall stones and Bile duct stones Flashcards
what is the treatment for asymptomatic gallstones?
No treatment is required
what are the two types of gallstone?
- cholesterol
2. pigment stones
what is the most common type of gallstone?
cholesterol
who is more likely to be affected by gallstones, men or women?
Women 2-3x more likely than men
what 4 factors contribute to the formation of gallstones?
- Bile contains too much cholesterol.
- Bile contains too much bilirubin.
- Gall bladder doesn’t empty correctly - bile becomes very. concentrated.
- Not enough bile salts.
what are risk factors for developing gallstones?
Gallstone Risk Factors (4 Fs)
Fat
Fair
Female
Forty
what are some clinical features of gallstones?
- biliary colic: Severe constant pain that has a crescendo characteristic.
- Initial site of pain is epigastrium but there may be a right upper quadrant component.
- Pain may radiate over the right shoulder/subscapular region.
- Nausea and vomiting may accompany the more severe attacks.
what are some clinical features of common bile duct stones?
- Biliary colic/abdominal pain.
- Fever.
- Jaundice (acute cholangitis).
what is biliary colic?
Intermittent right upper quadrant pain caused by gallstones irritating bile ducts
This pain is constant and cannot be relieved - may sometimes be triggered by fatty foods.
which other conditions present in a similar way to symptomatic gallstones?
- Acute hepatitis.
- Bile duct stricture.
- Gallbladder polyps.
- Gastritis.
- Gastro-oesophageal reflux disease.
- Inflammatory bowel disease.
- Irritable bowel syndrome.
- Non-biliary acute pancreatitis.
- Peptic ulcer disease.
- Tumours of the gallbladder, liver, stomach, gut, and pancreas.
how would you investigate and manage gallstones?
- LFTs and ultrasound
- MRCP (Magnetic Resonance Cholangio-Pancreatography) if you can’t see stones on USS
- ERPC (Endoscopic Retrograde Cholangio-Pancreatography) - Indicated for established CBD stones / obstructing ductal tumours on USS or MRCP
- Cholecystectomy
what is meant by Cholecystitis?
gallbladder inflammation
what is meant by Pancreatitis?
inflammation of pancreas
how would you treat symptomatic cholithiasis?
Laparoscopic Cholecystectomy
what are the risks of a Laparoscopic Cholecystectomy?
- bile leak
- bleeding
- infection
- injury to near by structures such as bile duct live and small intestine
- risks of general anaesthesia such as blood clots and pneumonia.
