Gallstone disease Flashcards
How do gallstones form?
Solids settling from a solution
Name the contents of bile solutions
Bilirubin
Bile pigments
Phospholipids
Cholesterol
Classify gallstones according to their contents
- Cholesterol
- Mixed
- Pigment
What type are the majority of gallstones?
Cholesterol
Explain the 3 phases of cholesterol stone formation
- Supersaturation
- Nucleation of cholesterol crystals
- Stone growth
What is the dark colour in pigment stones due to?
Contain calcium bilirubinate
Give characteristics of black stones
Small, brittle, spiculated
Assoc w/ haemolysis
Form in the gallbladder
Give characteristics of brown stones
Usually <1cm
Soft and mushy
Assoc w/ bacterial infection
Primarily form in the bile ducts
Which bacteria are linked to brown stones?
Bacteria that secrete beta-glucuronidase -> UB that precipitate with calcium and dead bacterial cells
What is biliary sludge?
Mixture of cholesterol crystals, calcium bilirubinate and mucin-gel matrix
What condition is biliary sludge associated with?
Fasting
Name complications of gallstone disease
Gallbladder
- acute/chronic cholecystitis
- abscess
- hydrops
- Mirizzi syndrome
- Bouverette syndrome
- cancer
Biliary
- choledocholithiasis
Pancreatic
- acute pancreatitis
Discuss the management of cholangitis according to the Tokyo guidelines
Mid - antibiotics - biliary drainage Moderate - fluid resus - antibiotics - urgent drainage <48h Severe - fluid resus - organ support - antibiotics - emergency drainage <24h
Which criteria are necessary for diagnosis of moderate acute cholangitis?
- WCC (<4, >12)
- Temperature >38
- Age>75yo
- Bilirubin >50
- Albumin <73% lower limit of normal
Name clinical features of acute cholecystitis
Murphy’s sign
Systemic inflammation
