Complications of Gallstones Flashcards
What is acute cholecystitis?
Inflammation of the gallbladder
What is acute cholangitis?
Inflammation of the bililary tree
What is ascending cholangitis?
Infection of the biliary tree
What are the presenting features of acute cholecystitis?
Right upper quadrant/epigastric pain- radiating to right shoulder tip
Fever
Nausea and vomiting
Right upper quadrant tenderness
Murphy’s sign positive
What sign will be positive in someone with acute cholecystitis?
Murphy’s sign
What can also occur if there is associated biliary obstruction?
Jaundice (pale stool and dark urine)
What is the name of the triad of symptoms that ascending cholangitis can present with?
Charcot’s triad
What is charcot’s triad?
Right upper quadrant pain
Fever
Jaundice
What can ascending cholangitis also present with if sepsis/severe infection occur?
Hypotension and confusion
What are the common causes of ascending cholangitis?
Biliary calculi (stones) – 50%
Benign biliary stricture – 20%.
Malignancy
What is Murphy’s sign?
Palpating the right subcostal area during inspiration- positive if the patient feels pain and stops breathing
What blood results would you find in someone with acute cholecystitis?
Deranged LFTs with a raised CRP
What is the initial imaging used?
Ultrasound scan
What is the management of acute cholecystitis?
Cholecystectomy within 48 hours
What else can be used in the management of acute cholecystitis and cholangitis?
Resuscitation including intravenous fluids and antibiotics
What is the main management of cholangitis?
ERCP
How can gallstone ileus occur?
Gallstone erodes through the gallbladder wall, resulting in a fistula between the gallbladder and small bowel
What is gallstone ileus?
A large gallstone travels through this fistula and gets trapped in narrow areas of the bowel leading to small bowel obstruction.
How can gallstone ileus be diagnosed?
Seen on x-ray imaging
What might you find on an x-ray of someone with gallstone ileus?
Air in the biliary tree (pneumobilia) and dilated small bowel
What is the management of gallstone ileus?
Laparotomy and removal of the gallstone from small bowel
What is another complication of gallstones?
Cholangiocarcinoma
What is cholangiocarcinoma?
Cancer of the bille ducts
