Gall Stones

Question 1

What are the different types of gallstones?

Answer 1

Pigmented
Cholesterol
Mixed

Question 2

Geographically, where ar the different types of gallstones seen?

Answer 2

Cholesterol = Western countries due to too much bile salts and cholesterol
Pigmented = Developing countries due to bacterial or parasitic infections

Question 3

What are the characteristics of people who get gall stones?

Answer 3

Fat
Fair
Female
Forty
Fertile

Question 4

What are the various conditions that arise with symptomatic gallstones?

Answer 4

Biliary Colic
Acute Cholecystitis
Choledocholithiasis

Question 5

What are the symptoms of biliary colic?

Answer 5

Sudden onset severe pain in the RUQ/epigastrium. Can radiate to the back. Tends to only last for a couple of hours Nausea and vomiting
No systemic response

Question 6

Why does biliary colic occur?

Answer 6

Gallstone becomes acutely impacted in the cystic duct leading to pain

Question 7

What are the symptoms of acute cholecystitis?

Answer 7

Severe RUQ/epigastric pain which can radiate to the back
Nausea and vomiting
Pain tends to last longer than three hours
Fever is common

Question 8

Give the pathophysiology for acute cholecystitis

Answer 8

Stones can impact in the neck of the bladder or in the cystic duct which causes inflammation and distension of the gallbladder wall. This can cause local peritonism. If the stone moves to the common bile duct then obstructive jaundice and cholangitis may occur.

Question 9

What clinical signs can you elicit in cholecystitis?

Answer 9

Murphy’s sign

• Place hand over R costal margin, midclavicular line
• Get the patient to breath in
• Patient will stop breathing due to pressure on gall bladder

Question 10

Define cholangitis

Answer 10

Infection in the common bile duct Causes: RUQ pain

Question 11

What symptoms does cholangitis cause?

Answer 11

RUQ pain
Jaundice
Rigors

Question 12

How is cholangitis treated?

Answer 12

Cefuroxime (1.5g/8hr) or metronidazole (500mg/8hr)

Question 13

Define choledocholithiasis

Answer 13

The presence of gall stones in the common bile duct

Question 14

What symptoms do you get in choledocholithiasis?

Answer 14

Jaundice (obstructive)FeverRUQ pain

Question 15

What is the treatment for CBD stones and obstructive jaundice?

Answer 15

ERCP - sphincterotomy and biliary trawl

Followed by cholecystectomy

Question 16

What investigations will be deranged in acute cholecystitis?

Answer 16

Increased WCC - thick walled GB which is also shrunken

Question 17

What is the treatment for acute cholecystitis?

Answer 17

Nil by mouth
Analgesia
Cholecystectomy within 72 hours or within 6-12 weeks

Question 18

What are the indication for cholecystectomy?

Answer 18

Symptomatic gal stones

Question 19

Define gallstone ileus

Answer 19

Gall stones erodes through the wall of the gallbladder and duodenum. It can go on to obstruct the terminal ileum.

Question 20

Give some complications of gallstones

Answer 20

Biliary colic
Acute and chronic cholecystitis
Empyema
Mucocoele
Carcinoma
Obstructive jaundice 
Pancreatitis
Cholangitis
Gallstone ileus

Question 21

What are the treatment options for someone with cholecystitis?

Answer 21

Open or lap. cholecystectomy
ERCP
Percutaneous drainage of the gall bladder (reserved for the very frail)