Gallbladder Disorders

Question 1

define cholelithiasis (gallstones)

Answer 1

presence of one or more gallstones in the gallbladder or other parts of the biliary tree

Question 2

causes of gallstones

Answer 2

arise due to issues with chemical composition of bile (e.g. cholesterol supersaturation and gallbladder motility)

Question 3

types of gallstones

Answer 3

pigment stones
cholesterol stones
mixed stones

Question 4

risk factors of gallstones

Answer 4

crohns disease 
diabetes 
obesity 
NAFLD 
female sex

Question 5

clinical features of gallstones

Answer 5

mostly asymptomatic but can present with intermittent RUQ/epigastric pain and nausea + vomiting

Question 6

what are characteristics of pain due to gallstones

Answer 6

often associated with eating large/fatty meals

typically occurs in mid-evening until morning

Question 7

does location of gallstones affect presentation?

Answer 7

YES! those in cystic duct/gallbladder will not cause abnormal lab results but those in common bile duct will

Question 8

differentials of gallstones

Answer 8

acute hepatitis
GORD
peptic ulcer
IBD/IBS

Question 9

investigations of gallstones

Answer 9

US of gallbladder
AXR
LFTs on bloods

Question 10

management of gallstones if asymptomatic

Answer 10

provide reassurance that do not require treatment unless develop symptoms
explain commonality
provide prophylactic treatment

Question 11

management of gallstones if symptomatic

Answer 11

IV morphine and antiemetic

elective cholecystectomy

Question 12

common complications of gallstones

Answer 12

acute cholecystitis
acute pancreatitis
obstructive jaundice
choledocolithiasis

Question 13

definition of cholecystitis

Answer 13

an inflammation of the gallbladder due to cholelithiasis that can develop to infection

Question 14

infective causes involved in cholecystitis

Answer 14

e.coli
klebsiella
enterococcus

Question 15

risk factors in cholecystitis

Answer 15

obesity
female sex
diabetes
increasing age

Question 16

clinical features of cholecystitis

Answer 16

RUQ/epigastric pain (radiates to right shoulder)
RUQ tenderness 
fever
nausea + vomiting 
\+ve Murphys sign

Question 17

differentials of cholecystitis

Answer 17

gallstones 
peptic ulcer disease 
acute cholangitis 
hepatitis 
pancreatitis

Question 18

clinical features of cholecystitis WITH biliary obstruction

Answer 18

jaundice
dark urine
pale stools
classic cholecystitis symptoms

Question 19

investigations for cholecystitis

Answer 19

US - thickened GB wall and pericholecystic fluid in GB/GB wall
bloods - raised WCC and abnormal LFTs

Question 20

management of cholecystitis

Answer 20

cholecystectomy 
supportive care (e.g. nil by mouth, IV fluids, antibiotics and analgesia)

Question 21

common complications of cholecystitis (untreated)

Answer 21

necrosis of gallbladder wall
perforation of the gallbladder
biliary peritonitis
jaundice

Question 22

define cholangitis

Answer 22

an inflammation of the bile duct that can ascend into the biliary tree

• commonly caused by bacterial infection
• 2nd to gallstones in some cases

Question 23

causes of cholangitis

Answer 23

obstruction of biliary tree (2nd to gallstones)
infection post-ERCP
malignant invasion
roundworm or liverfluke infection

Question 24

risk factors of cholangitis

Answer 24

ERCP operation
HIV +ve status
cholangiocarcinoma
pancreatic/liver cancer

Question 25

clinical features of cholangitis

Answer 25

charcots triad: 
jaundice 
fever 
RUQ pain 
\+ve Murphys sign
reynolds pentad

Question 26

differentials of cholangitis

Answer 26

diverticular disease
hepatitis 
pancreatitis 
cirrhosis
liver failure

Question 27

investigations of cholangitis

Answer 27

abdominal US
AXR
contrast enhanced CT
ERCP

Question 28

blood results of cholangitis

Answer 28

⬆️ WCC, LFTs, ESR + CRP
abnormal U+E and RFTs
blood cultures

Question 29

management of cholangitis

Answer 29

prompt IV fluids, antibiotics and catheterisation

elective ERCP or cholecystectomy

Question 30

common complications of cholangitis

Answer 30

septic shock

intra-abdominal collection