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Big Surgery > Cholelithiasis > Flashcards

Cholelithiasis Flashcards

1
Q

What is the definition of cholelithiasis?

A

-the formation of gallstones in the gallbladder

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2
Q

What age does it usually occur?

A

-40 years

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3
Q

Why is it more prevalent in females than males?

A

-increased incidence of oestrogen

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4
Q

What are the 3 types of gallstones?

A
  1. cholesterol stones
  2. black stones
  3. brown stones
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5
Q

What is the pathophysiology of the formation of gallstones?

A
  • hypersaturation of cholesterol,calcium carbonate, bile salts and bilirubin
  • biliary stasis
  • decreased gallbladder emptying(pregnancy, bowel obstruction or prolonged parenteral feeding) which leads to cholestasis
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6
Q

What are the 6 F’s?

A
  1. fat
  2. female
  3. famiy history
  4. fair skinned
  5. forty
  6. fertile
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7
Q

What are the risk factors for cholesterol stone formation?

A
  1. family history
  2. obese
  3. female
  4. above 40
  5. drugs-fibrates, oral contraceptives
  6. pregnancy
  7. malabsorption(crohns disease, ileal resection)
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8
Q

What is the pathophysiology of cholesterol stone formation?

A
  • increased concentration of cholesterol in the bile
  • decreased bile salts and lecithin which leads to the bile being hypersaturated
  • the cholesterol and he calcium carbonate precipitates out and forms cholesterol stones or mixed stones
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9
Q

How do the black stones form?

A
  • They occur 10% of the time
  • caused by increased haemolysis which leads to increased unconjugated bilirubin and conjugated bilirubin uptake and the formation of black stones
  • they are soft and crumble easily
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10
Q

How do the brown/mixed stones form?

A

-They occur 10% of the time

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11
Q

What are the risk factors for black stones?

A
  • chronic haemolytic anaemias(sickle cell disease, hereditary spherocytosis)
  • cirrhosis
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12
Q

What are the clinical features of patients with gallstones?

A
  • usually asymptomatic
  • if they have pain: biliary colic dull RUQ pain that lasts <6 hours
  • if it is referred then it goes to the epigastrium, right shoulder and the back
  • usually post-prandially (right after eating)
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13
Q

What are the diagnostic tests we can do for cholilithiasis?

A
  • RUQ ultrasound is the best
  • MRCP(magnetic resonance cholangiopancreatography) or EUS(endoscopic ultrasound)
  • labs will be normal if uncomplicated(WBC, amlase and bilirubin)
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14
Q

Why do we not use X-ray?

A
  • most stones are radiolucent(cholesterol stones)

- whereas 10-15% are radio-opaque

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15
Q

What is the difference between ERCP and MRCP?

A

-ERCP is used for interventions like stoe removal
MRCP-is only used for diagnostics and does not use contrast but we can view the intrahepatic and extrahepatic as well as the pancreatic duct

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16
Q

What conservative Rx can we give he patient?

A
  • dietary changes
  • spasmolytics
  • analgesia
17
Q

What is the Rx for cholelithiasis?

A

-laparoscopic cholecystecomy
-indicated when you have symptomatic cholelithiasis
or asymptomatic but at risk for gallbladder cancer

18
Q

What are the complications for cholelithiasis?

A
  1. choledocholiathis
  2. cholangitis
  3. cholecystitis
  4. mirizzi syndrome
19
Q

What is the alternative for patients with cholelithiasis that do not want to get surgery?

A
  • They can medical management called medical/oral litholysis
  • for 6 months
  • You can consume bile salts
20
Q

How is cholesterol and food items taken into the bile acid?

A

-bile salts and phospholipids are amphiphatic(both have hydrophillic and hydrophoic elements) that help keep the cholesterol in he vesicles and don’t forge into stones

21
Q

What age do cholesterol stones develop in?

A
  • older
  • obese
  • rapid weight loss
  • developed countries
22
Q

What age do pigment/black stones develop in?

A

-younger patients

23
Q

How long does biliary colic occur for if we are dealing with symptomatic choleliathis?

A

-minutes to 2 hours

-

24
Q

What triggers the biliary colic?

A
  • fried oily foods

- after meals

25
Q

What is the criteria for a normal cholangiopancreatogram?

A
  1. normal intrahepatic ducts
  2. no filling defects
  3. smooth common bile duct
  4. good free flow of contrast into the duodenum
  5. no strictures or narrowing of the common bile duct
26
Q

What are the 3 ways that patients with gallstones present?

A
  1. asymptomatic
  2. symptomatic , uncomplicated
  3. symptomatic, complicated
27
Q

What are the two ways that symptomatic patients present with gallstones?

A
  1. Biliary dyspepsia where there is upper abdominal pain, aversion to fatty food and flatulence
  2. Biliary colic- right upper quadrant pain which radiates to the right scapula and is colicky(6-8 hours), vomiting and nausea
    They also have tenderness over the galbladder and we treat with IV spasmolytic
28
Q

Under what special circumstances would we consider surgery for asymptomatic patients?

A
  1. DM
  2. > 2CM gallstones
  3. gallstones in the common bile duct
  4. patients who cannot afford a long stay in hospital
29
Q

What surgery do we do for gallstones?

A

open or laparoscopic cholecystectomy

30
Q

What are the benefits of doing laparoscopic cholecystectomy?

A
  1. shorter hospital stay
  2. Better and faster return to baseline
  3. superior cosmetic result
  4. less post-operative respiratory complications
31
Q

What are the alternatives to gallstone removal that only work on cholesterol stones and can cause recurrence of stones?

A
  1. bile salt oral intake

2. extracopreal shockwave lithotripsy

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