FN: Biliary Colic

Question 1

Pathogenesis

Answer 1

Gallbladder spasm against a stone impacted in the neck of the gallbladder - HArtmanns Pouch
Less ocmmonly, the stone may be in the CBD

Question 2

Presentation

Answer 2

RUQ pain radiating - back (scapula region)
Assoc. with sweating, pallor, n/v
Attacks may be ppted. by fatty food and last

Question 3

Differential

Answer 3

Cholecystitis/other gallstone disease
PAncreatitis
Bowel perforation

Question 4

Investigations

Answer 4

Same work up as cholecysitis as may be difficult to differentiate clinically
Urine: bilirubin, urobilinogen, Hb
Bloods: FBC, U+E, amylase, LFTs,G+S, clotting, CRP

Question 5

Imaging

Answer 5

AXR: 10% gallstones are radio-opaque
Erect CXR: look for perforation
US:
1. Stones: accoustic shadow
2. Dolated ducts: 6mm
3. Inflamed GB: wall oedema

Question 6

If diagnosis uncertain after US

Answer 6

HIDA cholescintigraphy: shows failure of GB filling (requires functioning liver)

Question 7

If dilated ducts seen on US –>

Answer 7

MRCP

Question 8

Treatment

Answer 8

conservative vs. Surgical

Question 9

Conservative

Answer 9

Rehydrate and NBM
Opiod analgesia: morphine 5-0mg/2h max
High recurrence rate therefore surgical Rx favoured

Question 10

Surgical

Answer 10

As for conservative + eother:
1. Urgent lap chole (same admission)
Elective lap chole @ 6-12 wks