Diseases of the Gallbladder Flashcards
Name diseases of the gall bladder?
- gallstones (cholelithiasis) - most common 2. Then cholecystitis (acute or chronic) 3. Congenital anomalies like agenesis 4. Carcinoma of the gallbladder
List the two main types of gallstones and briefly explain their demographics?
- cholesterol stones 2. pigment stones
Describe cholesterol stones?
- Contain 80% crystalline cholesterol monohydrate 2. yellow in colour
Epidemiology?
common in the Europe, America - industrialised countries
Describe pigment stones?
- Common in low social-economic populations 2. Composed of bilirubin calcium salts
List the risk factors for the development of cholesterol stones?
- : industrialised countries: America and Europe 2. advancing age 3. Female sex hormones 4. obesity 5. rapid weight reduction 6. gallbladder stasis 7. Inborn error of bile acid metabolism 8. Hyperlipidaemia syndromes
List the risk factors for the development of pigment stones?
- demography - Low socio-economic status + rural and urban poor 2. Chronic haemolytic syndromes 3. Biliary infection
Discuss the pathogenesis of cholesterol stones?
- Excess cholesterol in bile (hypersaturation) as a result of liver hypersecretion of cholesterol Gallbladder hypomotility: toxic effects of cholesterol on mucosa 2. Cholesterol nucleation in gallbladder 3. Mucous in gallbladder traps the crystals growing into macroscopic stones 4. ?
Discuss the pathogenesis of pigment stones?
- Mixture of unconjugated bilirubin with inorganic calcium salts 2. Unconjugated bilirubin increases with infection of the biliary tract (E.coli, Ascaris etc) 3. Haemolytic anaemias increases bilirubin concentration
Describe the morphology of cholesterol stones?
- round to ovoid, multifaceted 2. Fine granular, hard surface, glistening 3. Radio-lucent
Describe the morphology of pigment stones?
- black or brown in colour 2. usually soft 3. radio-opaque
What are the clinical features of gallstones?
- Majority are asymptomatic 2. Right upper abdominal colicky pain (spasmodic) 3. Concomitant cholecystitis
What are the investigations that can be taken?
- Ultrasound scan 2. Xrays
List the complications of gallstones?
- Gallbladder empyema
- Perforation
- Cholangitis: inflammation of biliary tree
- Obstructive cholestasis with jaundice 5. Acute pancreatitis
- Increased risk of gallbladder carcinoma
What is cholecystits?
inflammation of the gallbladder - can acute or chronic
Describe acute cholecystitis?
- Usually in association with gallstones (calculous cholecystitis) 2. Can be alcalculous: in setting of severe systemic derangements
Acute cholecystitis is Associated with?
- Post-operative state after non biliary surgery 2. Severe trauma, severe burns 3. Multisystem organ failure 4. sepsis
Describe calculous cholecystitis?
- Chemical and physical irritation of the bladder with 2. subsequent inflammation
Describe acalaculous cholecystitis?
results from derangements that cause ischaemia to the gallbladder
What are the clinical features?
- Can present with sudden onset as an acute surgical emergency or as mild pain 2. Right upper quadrant pain 3. Epigastric pain 4. Mild fever, tachycardia 5. Sweating, nausea and vomiting 6. Tender abdomen
Describe chronic cholecystitis?
- Occur as a result of repeated bouts of mild to severe acute cholecystitis 2. Associated with cholelithiasis in majority 3. Symptoms similar to acute cholecystitis but indolent/protracted 4. Gallbladder wall is thickened and shows chronic inflammation
Complications of acute and chronic cholecystitis?
- Bacterial superinfection with sepsis 2. Gallbladder perforation 3. abscess formation 4. Gallbladder rupture with peritonitis 5. Biliary-enteric fistulas
