Gall stones

Question 1

What type are the majority of gall stones

Answer 1

Cholesterol stones

Question 2

How are non-cholesterol stones classified

Answer 2

Black (bilirubin and lots of mucin glycoproteins[chronic haemolytics and cirrhotics])
Brown (Worm infestation)

Question 3

When will cholesterol precipitate out of bile

Answer 3

Imbalance between concentration of cholesterol, bile salts and phospholipids

Question 4

What is lithogenic bile

Answer 4

High cholesterol low bile salt and phospholipid

Question 5

Of people with asymptomatic gall stones, how many will develop symptoms in the next year

Answer 5

2%

Question 6

Where do gall stones commonly lodge

Answer 6

Hartmann’s pouch

Cystic duct

Question 7

The investigation of choice for suspected gallstone disease is

Answer 7

abdominal ultrasound scanning

Question 8

Cholesystectomy involves

Answer 8

Dissection in Calot’s Triangle, ligation and division
of the cystic artery, ligation and division of the cystic duct, and removal of the gallbladder from the gallbladder
bed.

Question 9

When is medical treatment of gall stones performed

Answer 9

Asymptomatic gall stones

Question 10

What medical therapy is available for gall stones

Answer 10

Medical Dissolution therapy (acid to dissolve stones over 2 years)
Contact dissolution therapy (percutaneous irrigation with methyl terbutyl ether)
Extracorporeal shockwave lithotripsy (breaks down stones, can be painful when stones are passed)

Question 11

What is Murphey’s sign?

Answer 11

Pain on taking a deep breath when the examiner’s fingers are on the approximate location of the gallbladder.

Question 12

Natural history of acute cholycystitis

Answer 12

1. Resolution
2. Abscess formation
3. Perforation
4. Fistula formation

Question 13

Treatment of acute cholycystitis

Answer 13

Resus, analgesia and antibiotics.

Surgical removal

Question 14

What is choledocholithiasis

Answer 14

Stones in the common bile duct

Question 15

What is Courvoisier’s law

Answer 15

States that in the presence of an enlarged gallbladder which is non-tender and accompanied with mild jaundice, the cause is unlikely to be gallstones. Gall stones give small fibrotic gall bladders.

Question 16

How is choledocholithiasis investigated and treated?

Answer 16

LFTs show increased serum bili, ALP and GGT. The abdominal radiograph may show gallstones if they are radioopaque. The U/S will show the stones in the gallbladder, the dilated common bile duct, and stones in the common bile duct. The investigation
of choice in choledocholithiasis is the ERCP, which is both diagnostic and therapeutic. If stones are found in the common bile duct, a papillotomy or sphincterotomy can be performed and the stones removed by means of balloons or baskets.