Gall Stones

Question 1

What are gallstones made of?

Answer 1

Cholesterol (most common)

Mixed stones

Pigment stones (bile acid, phosphate, magnesium) - least common

Question 2

The liver makes bile, travels down biliary tree, down into _____ where its concentrated and stored

Answer 2

gall bladder

Question 3

What hormone causes gallbladder to contract?

Answer 3

CCK (cholecystokinin)

Question 4

Who is most at risk of gall stones?

Answer 4

5 Fs:
Fair, Fat, Female, Fertile, Forty

Also those with high turnover of RBCs (eg hereditary spherocytosis)

Question 5

What can gall stones cause?

Answer 5

Biliary colic
Jaundice
Pancreatitis
Cholecystitis (inflammation in bile duct)
Cholangitis

Question 6

Signs and symptoms of gall stones

Answer 6

Often asymptomatic

Biliary colic:
RUQ post-prandial colicky pain, worse with fats

Cholecystitis:
Constant pain
Fevers, rigors

Choledocholithiasis:
jaundice

Cholangitis:
Jaundice
Fever over 39 degrees Celsius

Question 7

What 3 things give high fever?

Answer 7

Viral, biliary sepsis, urinary tract

Question 8

Investigations for gall stones

Answer 8

Bloods: FBC, LFT, Coagulase, U&E, Amylase, lipase

Ultrasound

MRCP magnetic resonance cholangiopancreatography) vs ERCP

FBC and CRP (c-reactive protein test)

Vitamin K (fat-soluble)

Question 9

Mirrizzi syndrome

Question 10

Gallstone ileus

Answer 10

Constant inflammation can cause fistulation, can roll across bowel and cause obstruction.

Question 11

Treatment for cholecystitis

Answer 11

Antibiotics
Analgesia - NSAID with PPI
ERCP
Cholecystectomy
Bile duct exploration/ reconstruction