Cholelithiasis

Question 1

What is it?

Answer 1

Gallstones (in the gallbladder)

Question 2

What is the composition of a gallstone?

Answer 2

Cholesterol

Pigment

Question 3

What are the risk factors for gallstones?

Answer 3

Obesity
Diabetes
Older age (however can get in 20s)
Female
Contraceptive pill
Parity
Cirrhosis
Cystic fibrosis

Question 4

What percentage of patients are symptomatic?

Answer 4

10-30%

Question 5

What is the presentation of gallstones?

Answer 5

Asymptomatic
Dyspeptic symptoms
Biliary colic
Acute cholecystitis
Empyema (gallbladder is full of pus)
Perforation
Jaundice
Gallstone ileus (in the gut)

Question 6

What is choledocholithiasis?

Answer 6

Gallstones in the bile duct

Question 7

What causes choledocholithiasis?

Answer 7

Primary: form in bile duct
Secondary: form in gallbladder and migrate down

Question 8

What the relevance of choledocholithiasis in cholecystectomy?

Answer 8

Incidental at cholecystectomy

Post-cholecystectomy pain

Question 9

What symptoms can

choledocholithiasis cause?

Answer 9

Obstructive jaundice (painful): pain, jaundice, dark urine, pale stool, pruritus, steatorrhoea
Acute pancreatitis
Ascending cholangitis (Charcot's triad = jaundice, fever, RUQ pain)

Question 10

What do things that end in itis cause?

Answer 10

Fever / raised WCC

Question 11

What are the investigations?

Answer 11

Blood tests: LFT’s (AST, ALT, ALP), amylase/lipase, WCC
USS (best test)
ERCP
MRCP

Question 12

What is the management options?

Answer 12

Asymptomatic: do nothing
Non-operative treatment: dissolution, lithotripsy (some patients can’t go through surgery)
Operative: laparoscopic cholecystectomy ± on table cholangiogram (gold standard)

Question 13

How are stones in the common bile duct removed?

Answer 13

Laparoscopic exploration of CBD

ERCP: pre, intra, post op