Gallbladder Disease - Other

Question 1

What is Gallstone Ileus?

Answer 1

When a large gallstone causes small bowel obstruction.

Question 2

Clinical Presentation of Gallstone Ileus (4).

Answer 2

Cardinal Features of Bowel Obstruction i.e.

1. Colicky Abdominal Pain.
2. Vomiting.
3. Abdominal Distension.
4. Absolute Constipation.

Question 3

Pathophysiology of Gallstone Ileus.

Answer 3

The large gallstone enters the small bowel via a cholecystoenteric fistula which forms between the inflamed wall of the gallbladder and a loop of small bowel.

Question 4

What is ileus?

Answer 4

Cessation of normal peristaltic movements of the bowel as a reaction to any form of irritation around it e.g. post-operative or peritonitis.

Question 5

Why is gallstone ileus a misnomer?

Answer 5

If a gallstone obstructs the small bowel, the small bowel proximal to the obstruction will attempt to overcome the blockage via vigorous peristalsis.

Question 6

Commonest site of gallstone ileus.

Answer 6

Terminal ileum, around the ileo-caecal valve.

Question 7

Investigations of Gallstone Ileus.

Answer 7

X-Ray : Pneumobilia (Air in the Biliary Tree) and Dilated Small Bowel.

Question 8

Management of Gallstone Ileus.

Answer 8

Laparotomy (proximal to the site, not at the site) and removal of the gallstone

Question 9

What is Courvoisier’s Law?

Answer 9

In a jaundiced patient, the presence of a palpable gallbladder means that the jaundice is unlikely to be due to gallstones impacted in the biliary system.

Question 10

Explanation of Courvoisier’s Law.

Answer 10

A gallstone in the common bile duct is likely to have a fibrotic shrunken gallbladder, due to repeated episodes of biliary colic and acute cholecystitis so will be impalpable.