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Medicine & Surgery: Gastroenterology > Gallstones > Flashcards

Gallstones Flashcards

1
Q

What is the clinical presentation of the majority of gallstones?

A

Asymptomatic (80%)

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2
Q

What are the components of bile?

A

Cholesterol, bile pigments (from broken down Hb), and phospholipids.

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3
Q

What type of gallstone is described and what causes it?

Small, bilirubin and irregular.

A
  1. Pigment stones (5%)

2. Haemolysis

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4
Q

What type of gallstone is described and what causes it?

Large, yellow and coloured.

A
  1. Cholesterol stones (20%)

2. Fat, fair, female, forty, fertile.

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5
Q

What type of gallstone is described?

Calcium, bile pigment and cholesterol.

A

Mixed stones (75%)

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6
Q

What are the risk factors for developing cholesterol gallstones?

A

Fat, fair, female, forty, fertile, family history.

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7
Q

What is the primary risk factor for developing pigment gallstones?

A

Haemolytic anaemia increases bilirubin

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8
Q

Which form of inflammatory bowel disease predisposes to gallstones and why?

A
  1. Crohn’s

2. Malabsorption of bile salts from the terminal ileum.

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9
Q

What are the steps of gallstone formation?

A
  1. Supersaturation of cholesterol
  2. Not enough bile salts
  3. Gallbladder stasis
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10
Q

What are the complications of gallstones from least to most severe?

A
  1. Biliary colic
  2. Acute cholecystitis
  3. Chronic cholecystitis
  4. Ascending cholangitis
  5. Gallstone ileus
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11
Q

What is this a presentation of and what causes it?

RUQ pain which radiates to the back, typically worse post-prandially, nausea, vomiting, normal WCC, cannot sit still.

A
  1. Biliary colic

2. Transient obstruction of biliary tree typically by gallstones.

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12
Q

How is biliary colic investigated?

A
  1. Elevated ALP suggests obstruction of cystic common bile duct.
  2. Abdominal USS is the single best test
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13
Q

What is the treatment for biliary colic?

A
  1. Observation if asymptomatic
  2. Analgesia, NBM, IV fluids
  3. Laparoscopic cholecystectomy if cholelithiasis
  4. ERCP if choledocholithiasis
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14
Q

What is this a presentation of and what causes it?
RUQ/mid-epigastric pain, Murphy’s sign +ve, palpable tender gallbladder, nausea, vomiting, fever, local peritonism, raised WCC.

A
  1. Acute cholecystitis
  2. 90% caused by complete cystic duct obstruction which leads to damage of mucosa and acute inflammation within the gallbladder, bacterial growth from bile stasis.
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15
Q

How is acute cholecystitis investigated?

A
  1. FBC suggests and inflammatory process, high CRP.
  2. LFTs show a cholestatic picture - high ALP, GGT, conjugated bilirubin.
  3. USS shows a thick walled gallbladder
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16
Q

What is the treatment for acute cholecystitis?

A
  1. Most resolve spontaneously in a month when stone dislodges.
  2. NBM, analgesia, NSAIDs, IV fluids, antibiotics (co-amoxiclav).
  3. Laparoscopic cholecystectomy is treatment of choice fit for general anaesthetic.
17
Q

What is this a presentation of and what causes it?

RUQ pain after meals, fat intolerance.

A
  1. Chronic cholecystitis
  2. Chronic inflammation from stone lodging and dislodging over and over, gallbladder heals by fibrosis and shrinks in size.
18
Q

How is chronic cholecystitis investigated and treated?

A
  1. AXR may show ‘porcelain gallbladder’.

2. Cholecystectomy

19
Q

What is this a presentation of and what causes it?

RUQ pain, obstructive jaundice, fever.

A
  1. Ascending cholangitis
  2. Bile duct infection caused by E. coli - infection enters biliary tree via ampulla of Vater, from choledocholithiasis (gallstone or stricture).
20
Q

How is ascending cholangitis investigated?

A
  1. High WCC, ALP and GGT.
  2. Raised LFTs and bilirubin.
  3. Urea and creatinine in severe cases raised.
  4. Raised CRP
  5. USS to visualise CBD obstruction.
21
Q

What is the treatment for ascending cholangitis?

A
  1. ERCP best first intervention
  2. For large stones shockwave lithotripsy
  3. IV tazocin, ERCP, opioids
22
Q

What is gallstone ileus?

A

Stone erodes through the gallbladder forming a fistula into the duodenum which may obstruct the terminal ileum.

23
Q

What is seen on an AXR in gallstone ileus?

A

Pneumobilia, small bowel obstruction, gallstone.

24
Q

What is Courvoisier’s law?

A

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

25
Q

Which of these conditions present with right upper quadrant pain?

  1. Biliary colic
  2. Acute cholecystitis
  3. Ascending cholangitis
A

All three

26
Q

Which of these conditions present with a fever or a high WCC?

  1. Biliary colic
  2. Acute cholecystitis
  3. Ascending cholangitis
A

2 and 3

27
Q

Which of these conditions present with jaundice?

  1. Biliary colic
  2. Acute cholecystitis
  3. Ascending cholangitis
A

Only 3

Medicine & Surgery: Gastroenterology (42 decks)

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