gall bladder issues Flashcards
types of gall stones that can occur and risk factors for each
Cholesterol- 85% - Female, Forty, Fair-hair, Fair-skinned, Fertile
pigment stones 10% (calcium bilirubinate)
mixed- 5%- infection
Risk Factors
· 5 Fs (see above)
· Crohn’s disease => due to the malabsorption of bile salts from the terminal ileum
· Haemolytic anaemia
· Family history of gall-stones
· Sudden loss of weight from obesity
complications of gall stones
3 clinical presentations can cause biliary colic
acute cholecystitis
ascending cholangitis
complications of the clinical presentations.
gall bladder empyema
gallstone ileus (adhesions –> fistula –> iliocecal junction blockage) - peristalsis is not lost however
pancreatitis
Gall bladder perforation,
liver abscess
mucocele
empyema
biliary peritonitis.
what is biliary colic, how does it present and how is it managed
impaction of cycstic duct
presentation: colic RUQ pain- radiates to back or tip of scap.
worse with fatty foods.
Mx: analgesia, lifestyle modifications, elective laparoscopic cholecystectomy 6 weeks after symptoms. If no symptoms conservative mx.
Pethidine, morphine, tramadol.
if the impacted stone rubs enough will cause acute cholecystitis
what is acute cholecystitis
impaction of the cystic duct and infection
(exception- acute acalculous cholecystitis- ischaemic cause)
Presentation: RUQ pain, Fever, Murphys sign
Mx with Co-Amoxiclav +/- Metronidazole, fluid resus, NG, NBM, analgesia, lap cholecystectomy within 48 hrs.
liver function is typically normal with this population group.
Ascending cholangitis
Gall stone impaction of common bile duct (choledocholithiasis) with infection causes this
o Biliary obstruction => stasis => predisposes superimposed infection, this is usually gut bacteria (gram negative, E.coli, Klebsiella)
o Presents with RUQ pain, fever, obstructive jaundice (Charcot’s triad) pruritis, pale stools, dark urine
o Mx: Fluid resus, antibiotics, endoscopic biliary decompression by ERCP
o Left untreated, infection may ascend up to the liver, causing abscesses ± sepsis
never do a lap cholecystectomy –> stone needs to be removed or will cause biliary peritonitis. remove GB 6 weeks later.
how to investigate gall stone caused diseases
FBC- WCC + CRP raised in cholecystitis + cholangitis
LFT- hyperbilirubinemia raised ALP
serum amylase- to R/O pancreatitis.
trans-ab ultrasound/ CT- look for distended gallbladder, + bile duct thickness.
MRCP- gold standard but not 1st line.
which bacteria love the gall bladder and make it their home
Salmonella, typhi. - cause a mucocele –> rupture and surgical emergency.
