Gall stones

Question 1

If children are found to have gallstones, what are their usual complaints?

Answer 1

None –

Gall stones in kids are usually “clinically silent”

(may have right upper quadrant pain,

nausea, and vomiting, if symptomatic)

Question 2

Why do children on TPN have a higher likelihood of developing gallstones?

Answer 2

It is associated with decreased bile flow

Question 3

What is the association to rapid weight loss and gallstones in adolescence?

Answer 3

Stones stimulate pancreatitis more often with rapid weight loss

Question 4

Why would resection or poor function in the ileum contribute to gall stone formation?

Answer 4

Less functional ileum = less bile acids

this means that the cholesterol is more concentrated & tends to form more stones

Question 5

What hematological disorder is famous for causing gall stones?

Answer 5

Sickle cell

pigmented stones

Question 6

How reliable is Murphy’s sign in children less than 10 years old?

(Murphy’s = patient stops taking a breath in, when you push on the right upper quadrant)

When is ERCP indicated (mainly)?

Answer 6

Not reliable

(Their presentation is usually nonspecific)

For evaluation & possible treatment of common bile duct stone

Question 7

For symptomatic patients, is medical therapy of cholesterol stones a good option?

Answer 7

No –

Low success rate and they will recur when the med is stopped

Question 8

If a sickle cell patient is found to have gall stones, but is asymptomatic, what is the recommended management?

Answer 8

Cholecystectomy

Gall stones have a high risk for complications in sickle cell patients

Question 9

What two common pediatric genetic disorders are associated with an increased risk of gall stone development?

Answer 9

Down syndrome

   &

Cystic fibrosis