Gall stone disease

Question 1

What are the four types of gall stones present

Answer 1

1. Mixed stones - made up of cholestrol and pigments, most common (70- 90%)
2. Cholestrol stones - 10% of all stones - generally large in size
3. Pigment stones - common in less developed countries
4. Calcium carbonate ( rare )

Question 2

What are the risk factors for gall stones

Answer 2

Fat 
Female 
Forty
Family history
Fair ( Caucasian ) 
Fertile
Contraceptives, crohns due to malabsorption, pregnancy

Question 3

What are 12 complications of gall stones

Answer 3

1. Biliary colic
2. Acute cholecystitis
3. Ascending cholangitis
4. Pancreatitis
5. Cholecysto-duodenal fistula causing gall stone ileus
6. Cholecysto-duodenal fistula causing Bouverets syndrome
7. Gall bladder empyema
8. Gall bladder carcinoma
9. Chronic cholecystitis
10. Jaundice
11. Gall bladder perforation
12. Acute suppurative cholecystitis

Question 4

What are the clinical features of biliary colic pain

Answer 4

• Intermittent colicky pain
• Dull pain
• Pain occurs after a fatty meal
• RUQ pain

Question 5

Where is the gall stone in biliary colic

Answer 5

Situated in the neck of the gall bladder

Question 6

Clinical features of acute cholecystitis

Answer 6

• > Constant RUQ pain
• > Fever
• > Hepatomegaly
• > Murphy’s sign
• > Pain radiating to the Shoulder

Question 7

Which lab tests would you order to investigate gall stone disease

Answer 7

• > LFT
• > CRP and ESR
• > U&Es
• > FBC
• > Amylase

Question 8

What are the imaging tests you would order to investigate Gall stone disease

Answer 8

• > USS abdo - dilated ducts, thickened gall bladder
• > FAST
• > MRCP
• > ERCP
• > EUS
• > intra operative

Question 9

How do you manage biliary colic

Answer 9

• Initial conservative treatment - Analgesia + Opioids PRN + antiemetic + lose weight, better diet,
• definitive treatment if recurrent biliary colic => elective cholecystectomy

Question 10

How would you treat acute cholecystitis

Answer 10

Initial - IV Abx, IV fluid, if perf - can get sepsis and therefore do sepsis 6, NG tube if vomiting, NBM as USS better without bowel gas, analgesia

Definitive - lap chole within 1wk, if still got RUQ pain after surgery then consider stone in CBD

Question 11

Explain bourverets and gall stone ileus

Answer 11

B = gall stone impacts in the duodenum causing gastric outlet obstruction

GI - stone impacted in the terminal ileum