Gallbladder disease Flashcards
What does bile contain
Water
Cholesterol
Bile pigments
Phospholipids
How is bile secreted by gallbladder
Bile produced in liver
Then stored and concentrated in gallbladder
Lipid rich food in duodenum stimulates CCK release which causes Gallbladder contraction. Bile passes from the hallbladder into the duodenum
What results in gallstone formation
Supersaturation of bile
factors which contribute to gallstone formation
Cholesterol supersaturation.
- Caused by increased plasma oestrogen [female, forty, fat, fair, fertile (one or more children), + fam history)
- Caused by depletion of the bile acid pool –> terminal ileum resection or disease
Stasis of bile
-Lack of stimulus to GB emptying (fasting, TPN)
Increased Hb breakdown
-Haemolytic disorders (spherocytosis, sickle cell or malaria)
What are the 3 gallstone compositions
Cholesterol (often solitary, smooth, large)
Mixed (predominantly cholesterol, multiple, generations range of colours and shapes)
Pigment (bile pigments, multiple, small, irregular and fragile)
What is cholelithiasis
Stones in the gallbladder
What is choledocholithiasis
Stones in the bile duct
What is cholestasis
reduction or stoppage of bile flow
What is biliary colic
when cystic duct becomes impacted by gallstone
Pain of biliary colic
Sudden, sharp, stabbing, RUQ- epigastric pain. Typically radiates to right shoulder and lasts <6h
Associations of pain of biliary colic
Eating (esp fatty foods)
Associated N&V
Examination findings of biliary colic
Apyrexial. typically unremarkable
Investigations nad management of biliary colic
Stones on USS
-Ultrasound, outpatient cholecystectomy
IS jaundice present in biliary colic
No as bile can still drain via common bile duct
What is cholecystitis
Stone impacted in neck go gallbladder or cystic duct results in super concentrate, irritant. Bile can get infected by ascending gut bacteria (klebsiella, e.coli)