Gallstones Flashcards
What conditions can occur as complications of gallstones?
Biliary colic CBD stones Obstrutive jaundice Acute cholecystitis Acute cholangitis Pancreatitis
What are the 5F which increase a persons risk of developing gallstones?
Fat Fair Female Forty Fertile
What is the typical symptoms associated with gallstones?
Biliary colic
=RUQ quadrant pain which is triggered by meals and can last for 30mins-8hrs
I..e due to stone moving and temporarily obstructing drainage of gallbladder (pain relieves when stones falls back into gall bladder)
Why do fatty meals particularly exacerbate biliary colic?
Fat in GI leads to secretion of cholecystokinin (CCK) from duodenum
-stimulates gallbladder to contract which produces pain when stones are present
How are the LFTs derranged in gallstones and why?
Bilirubin= unable to drain through bile ducts as normal
Raised ALP= indicates biliary obstruction when in context of symptoms
ALT/AST= may be slightly raised but not to same degree as ALP
What are the 2 main types of imaging used when gallstones suspected? What are the indications for each and what would you expect to find if gallstones where present?
USS
- 1st line= most sensitive initial imaging for gallstones
- can see gallstones and their acoustic shadow
- bile duct dilatation
- thickening of gall bladder wall
- state of pancreas and pancreatic ducts= look for signs of malignancy or pancreatitis
MRCP
-used when USS doesn’t show signs of stones but there is bile duct dilatation or raised bilirubin
What is the function of ERCP and how does it work?
Used to clear stones in bile duct and insert stents or take biopsy samples
Endoscope passed down oesophagus and along GI until sphincter of Oddi where contrast dye can then be injected to visualise the biliary tree
How are gallstones managed?
Most managed conservatively and can resolve w/o intervention
Surgical intervention includes cholecystectomy (Laproscopic)
What is post-cholecystectomy syndrome?
Symptoms which can arise after cholecystectomy which can be due to changes in bile flow
Diarrhoea Indigestion Epigastric pain/RUQ pain Nausea Intolerance to fatty foods Flactuence
What is Carlot’s triangle in relation to cholesystectomy?
Triangle bound by R lobe of liver, cystic ducts and common hepatic duct
Marks the most likely locations of the cystic artery which is important to identify before removing the gall bladder
What are the different classifications of gallstones?
Which are NOT visible on xray?
Cholesterol
- hard and yellow
- can be any size
- NOT visible on plain radiograph due to not being radio opaque
Pigment
- <25% cholesterol
- black and crumbly
- calcium bilirubinate
- 50% radio-opaque
Mixed
- 25-80% cholesterol
- layered
- most common form of gall stones (>60%)
What are the 2 different forms of CBD stones?
Primary
-stones form in CBD-> very rare
Secondary
- stones from gallbladder pass into CBD
- Mirizzi syndrome= gallstones erode through gallbladder + CBD wall directly into CBD.
How would someone with CBD stones present?
Asymptomatic
Obstructive jaundice (can degenerate into acute cholangitis) i.e. dark urine + pale stools
Pain in RUQ + back
Acute pancreatitis (if stone passes through ampulla vater)
Acute cholangitis
What investigations would you do if you suspected common bile duct stones?
LFTs = obstructive picture (raised bilirubin + ALP) USS= CBD dilation + stones MRCP= detailed biliary anatomy
How would you manage someone with CBD stones?
IV fluids to prevent renal injury
ERCP= sphincterotomy + stone removal
Surgery lap chole (when unable to use ERCP)
