Gall stones

Question 1

Epidemiology of Gallstones

Answer 1

In developed countries, about 10% of adults and 20% of people > 65 yr have gallstones
Prevalence less in Asians
High in African Americans - oestrogen

fair, fat, fertile, female and forty

Question 2

Aetiology of Gallstones

Answer 2

Obesity, pregnacy, gallbladder stasis, drugs, hereditary, Type 2 diabetes, cirrhosis,portal hypertension, Crohns,

Question 3

Pathology of Gallstones

Answer 3

when substances reach staturation dissolve out
Bile=crystals (grow)
Cholesterol/calcium+bilirubin complex

Question 4

Natural History

Answer 4

can develop into cholecystitis

(This follows impaction of a stone in the cystic duct, which may cause continuous epigastric or Right upper quadrant pain, vomiting, fever, local peritonism, or a GB mass.)

Question 5

Clinical Manifestations

Answer 5

pain upper right quadrant

Question 6

Symptoms

Answer 6

less than half patients are symptomatic
nausea/vomiting
pancreatitis
Perforation-peritonitis
chills
pain upper right abdomen
jaundice

Question 7

Signs

Answer 7

pain upper right quadrant
Murphy’s sign for Colic cystitis: lay two fingers over the RUQ. Ask the patient to breathe in -Gallbladder The sign is only positive if a similar manoeuvre in the left upper quadrant does not cause pain.

Question 8

Complications

Answer 8

cholecystitis

Biliary colic
(pain in the epigastrium or right upper quadrant and may radiate round to the back in the interscapular region.
persists from 15 minutes up to 24 hours, subsiding spontaneously or with analgesics.

Nausea or vomiting often accompanies the visceral pain, occurs as a result of distension of the gallbladder due to an obstruction or to the passage of a stone through the cystic duct)

Question 9

Prognosis

Answer 9

treated with surgery

less than half are symptomatic