Chapter 53: Biliary tract- Cholelithiasis Flashcards
What is it?
Formation of gallstones
What is the incidence?
≈10% of U.S. population will develop gallstones
What are the “Big 4” risk factors?
“Four Fs”:
- Female
- Fat
- Forty
- Fertile (multiparity)
What are the types of stones?
Cholesterol stones (75%)
Pigment stones (25%)
What are the types of pigmented stones?
- Black stones (contain calcium bilirubinate)
- Brown stones (associated with biliary tract infection)
What are the causes of black-pigmented stones?
- Cirrhosis
- hemolysis
What is the pathogenesis of cholesterol stones?
Secretion of bile supersaturated with cholesterol (relatively decreased amountsof lecithin and bile salts); then, cholesterol precipitates out and forms solid crystals, then gallstones
What are the signs and symptoms?
Symptoms of:
- biliary colic
- cholangitis
- choledocholithiasis
- gallstones
- pancreatitis
Is biliary colic pain really “colic”?
No, symptoms usually last for hours; therefore, colic is a misnomer!
What percentage of patients with gallstones are asymptomatic?
80% of patients with cholelithiasis are asymptomatic!
What is thought to cause biliary colic?
Gallbladder contraction against a stone temporarily at the gallbladder/cystic ductjunction; a stone in the cystic duct; or a stone passing through the cystic duct
What are the five major complications of gallstones?
- Acute cholecystitis
- Choledocholithiasis
- Gallstone pancreatitis
- Gallstone ileus
- Cholangitis
How is cholelithiasis diagnosed?
History
Physical examination
Ultrasound
How often does ultrasound detect choledocholithiasis?
≈33% of the time … not a very good study for choledocholithiasis!
How are symptomatic or complicated cases of cholelithiasis treated?
By cholecystectomy
What are the possible complications of a lap chole?
- Common bile duct injury
- right hepatic duct/artery injury
- cystic duct leak
- biloma (collection of bile)
What are the indications for cholecystectomy in the asymptomatic patient?
- Sickle-cell disease
- Calcified gallbladder (porcelain gallbladder)
- Patient is a child
What is choledocholithiasis?
Gallstones in the common bile duct
What is the management of choledocholithiasis?
- ERCP with papillotomy and basket/balloon retrieval of stones (pre- or postoperatively)
- Laparoscopic transcystic duct or trans common bile duct retrieval
- Open common bile duct exploration
What medication may dissolve a cholesterol gallstone?
Chenodeoxycholic acid, ursodeoxycholic acid (Actigall®); but, if medication isstopped, gallstones often recur
What is the major feared complication of ERCP?
Pancreatitis
