Gallstone Disease Flashcards
What are black (pigment) stones in children commonly associated with?
Black stones are most commonly associated with haematological diseases like haemolysis due to spherocytosis and sickle-cell disease, and are more common in Africa.
What are cholesterol stones in children commonly associated with?
Cholesterol stones are most common in Westernized countries and are associated with rising incidence in children due to high-fat diets and obesity.
What are mixed stones in children typically related to?
Mixed stones are often related to infection, such as biliary sludge secondary to parenteral nutrition.
What are some differential diagnoses for gallstone disease in children?
Differential diagnoses include biliary ascariasis, inspissated bile plug (e.g., cystic fibrosis), biliary rhabdomyosarcoma (very rare), and in neonates, causes of cholestasis.
What is biliary ascariasis and in which group is it more common?
Biliary ascariasis is caused by a high load of intestinal worms and is more common in older children. It may be seen on x-ray or ultrasound.
What is the clinical presentation of biliary colic in children?
Biliary colic presents as recurrent colicky episodes of epigastric pain, which is worse after high-fat meals.
What are the signs of acute cholecystitis in children?
Acute cholecystitis may present with fever (pyrexia) and tenderness over Murphy’s point (right upper quadrant).
What are the signs of acute pancreatitis in children?
Acute pancreatitis presents with severe abdominal pain and raised levels of amylase and lipase.
What is the most sensitive imaging investigation for gallstones in children?
Ultrasound is the most sensitive imaging technique for diagnosing gallstones.
What can an abdominal X-ray (AXR) show in gallstone disease, and what is its limitation?
AXR can show radio-opaque pigment stones, but it may miss sludge.
What laboratory investigations should be done in suspected gallstone disease?
Full blood count and smear should be performed to check for spherocytes, and a sickling test may be needed in children of central African or Mediterranean ancestry to screen for sickle cell disease. Markers of haemolysis (e.g., LDH) may be raised if pigment stones are present. Infectious markers may be raised in cases of acute cholecystitis.
What is the treatment for symptomatic gallstones in children?
The gold standard treatment for symptomatic gallstones is laparoscopic cholecystectomy.
When should cholecystectomy be performed for asymptomatic gallstones?
Cholecystectomy should be performed in patients with asymptomatic gallstones and haemolytic anaemia (e.g., hypersplenism in spherocytosis) undergoing elective splenectomy due to the high lifetime risk of gallstones.
What is the usual treatment for biliary sludge?
Conservative management is usually effective for biliary sludge. This includes ensuring adequate hydration and using choloretics like Ursodeoxycholic acid if the sludge is associated with parenteral nutrition.
How are pancreatico-biliary helminths, such as biliary ascariasis, treated?
The treatment includes high-dose broad-spectrum antibiotics for acute cholangitis, bowel rest, and analgesia. Most cases resolve spontaneously as the worms leave the biliary tree.
Why should antihelmintics not be given immediately in cases of biliary ascariasis?
Antihelmintics should not be given until the biliary tract is free of worms, as dead worms may require surgical removal (e.g., ERCP or open surgery).
When can Albendazole be given in cases of biliary ascariasis?
Albendazole can be given once the biliary tract is confirmed to be free of worms through imaging.
