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Y4 GI / Surgery > Gallstones > Flashcards

Gallstones Flashcards

1
Q

Biliary colic is also known as what

A

Cholelithiasis

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2
Q

What is biliary colic AKA cholelithiasis?

A

Stone irritating gallbladder or stuck in cystic duct or ampulla of Vater

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3
Q

Biliary colic

  • Where is the pain
  • Where does it radiate
  • What triggers it
  • What associated S+S
  • How long lasts
  • Makes you want to stay still or move around
A 
RUQ pain radiates to back
Triggered by eating (fatty foods)
Associated N+V
Lasts hours (subsides spontaneously)
-Makes you want to move (visceral pain)
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4
Q

FBC, CRP and LFTs may all be normal in biliary colic, true or false

A

True

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5
Q

What is the 1st line investigation for biliary colicWh?

A

US

(measure gallbladder wall thickness

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6
Q

Gallstones are normally radiolucent or radiopaque?

What colour is that - black of white?

A

Radiolucent black

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7
Q

What is the Mx of biliary colic?

A

Elective laparoscopic cholecystectomy

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8
Q

Lap chole complications

  • 5% get what
  • 1 in 250 get what
A

5% chronic diarrhea

1 in 250 bile duct damage

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9
Q

What is acute cholecystitis?

A

Stone stuck in neck of gallbladder causing inflammation +- ischaemia
(Risk progressing to necrosis if untreated)

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10
Q

Acute cholecystitis pain

  • where
  • radiates where
  • severe or mild
  • associated symptoms
  • lasts how long
  • want to stay still or move around
A 
RUQ
radiates shoulder tip/back
severe
assoc fever, N+V, tender
lasts longer than biliary colic
want to stay still (peritonism)
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11
Q

What is Murphy’s sign? what is it seen in? is it a reliable sign?

A

Lay 2 fingers over RUQ; pain when PTx inspires as inflamed GB touches examiner’s hand
In acute cholecystitis
Highly specific

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12
Q

What is the Mx of acute cholecystitis?

A

IV/PO ABx

LAP chole within 1wk of S+S onset

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13
Q

A gallbladder empyema is a complication of acute cholecystitis, what is the Mx of this?

A

Percutaneous cholecystostomy

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14
Q

What investigation is done for complications of acute cholecystitis?

A

CT

eg pancreatitis, gallbladder perforation, gallbladder empyema

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15
Q

What is ascending cholangitis?

A

Bile duct infection secondary to gallstone blocking biliary flow

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16
Q

What is Charcot’s triad?

A

RUQ pain + fever + obstructive jaundice

In ascending cholangitis

17
Q

What are the 4 Fs for gallstones?

A

Female
Fat
Fair
Fourty

18
Q

Statorrhea and bilirubinuria can be seen in ascending cholangitis - T or F

A

True

19
Q

How is ascending cholangitis diagnosed?

A

US poor at identifying stones in CBD

ERCP

20
Q

What is the management of ascending cholangitis?

A

IV ABx

Clear bile duct by lap chole or ERCP

21
Q

What is the management of incidentally found gallstones?

A

Doesn’t require intervention unless symptomatic

majority of gallstones don’t ever cause symptoms

22
Q

What investigation should be done for patients with upper abdo pain to exclude air under the diaphragm?

A

Erect CXR

23
Q

What management of gallstones is offered for frail elderly patients unfit for cholecystectomy? (i.e. can’t handle GA)

A

Percutaneous cholecystostomy
(inserted by an interventional radiologist)
(drains bile to skin)
(also given to patient with severely inflamed gallbladder while waiting for information to settle whilst awaiting surgery)

24
Q

At how many mm is the bile duct dilated?

A

9mm

25
Q

When investigating ascending cholangitis on US, if stones are not seen in the CBD but the duct is dilated or LFTs abnormal, what is done next?

A

MRCP

26
Q

‘A stone in the gallbladder pressing on the bile duct causing obstructive jaundice’ describes what

A

Mirizzi syndrome

27
Q

Most stones are made of cholesterol, in which locations can they not be seen on CT?

A

In gallbladder + common bile duct

28
Q

In a patient with cholecystitis, if they suddenly deteriorate what complication may have arisen? What do you do to diagnose it?

A

Gallbladder perforation
CT
Mx laparotomy

Y4 GI / Surgery (11 decks)

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