cholelithiasis

Question 1

formed where?

Answer 1

Cholelithiasis is the presence of solid concretions in the gallbladder. Gallstones form in the gallbladder but may exit into the bile ducts (choledocholithiasis)

Question 2

cause of symptoms i.e. pain, jaundice etc?

Answer 2

gallstones usually asymptomatic

Symptoms ensue if a stone obstructs the cystic, bile, or pancreatic duct

Question 3

5 complications?

Answer 3

cholecystitis (gall bladder inflam)
cholangitis (bile duct inflam)
pancreatitis

Sepsis
Obstructive jaundice

Question 4

Presenting symptoms?

Answer 4

Pain AFTER EATING

RUQ pain lasting MORE than 30 minutes;
Constant pain typically increases in intensity and lasts for several hours - then stabilises (biliary colic).

Radiates to back or shoulder

Responds to analgesia

Dyspepsia, heartburn, flatulence, and bloating are common but are not characteristic features of gallstone disease

maybe;
nausea & jaundice (if obstruction), epigastric tenderness

Question 5

risk factors?

Answer 5

FH gallstoens
female
obesity, DM, metabolic syndrome
octreotide - somatostatin analogue
ceftriaxone

fast weight loss or long fasting

Question 6

ivx?

Answer 6

FBC- wcc normal unless complication has ensued (cholangitis etc)

LFTS;

cholelithiasis: normal
choledocholithiasis: elevated ALP, elevated bilirubin

Abdo US -stones in corresponding place

amylase - elevated in ac pancreatitis

In AnE do PR with abdominal pain presentation

ercp or mrcp - shows stones

Question 7

management?

Answer 7

Not symptomatic;
1. Observation

If symptomatic;

1. Analgesia + anti-spasmodic (paracetamol + Buscapan (hyoscine))
   1b. Cholecystectomy

Choledocolithiasis;
1. ERCP with biliary sphrincterectomy or stone removal

Question 8

Differentials?

Answer 8

Peptic ulcer disease
GORD - ask if abdo pain worse at night lying down
Acute pancreatitis