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Upper GI surgery > Gallstones > Flashcards

Gallstones Flashcards

1
Q

Name four risk factors for gallstones

A

4 F’s

Female, fat, fourty, fertile

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2
Q

Name three types of gallstones

A

cholesterol, pigment, mixed

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3
Q

State four investigations for gallstones

A

LFTS, USS, MRCP, ERCP, HIDA scan

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4
Q

Which investigation is both diagnostic and therapeutic?

A

ERCP

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5
Q

Which four complications can arise from gallstone formation?

A 
acute cholecystits 
ascending cholangitis 
biliary colic 
obstructive jaundice (choledocolethiasis) 
acute pancreatitis 
gallstone ileus
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6
Q

What are the symptoms of gallstone formation?

A

RUQ pain (can be constant or colic depending on whether infection)
Pain related to eating + fatty food
N/V
Jaundice (not in biliary colic or cholecystitis)
fever

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7
Q

In which gallstone conditions would fever arise?

A

cholecytisis and cholangitis

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8
Q

What is the treatment for gallstones?

A

cholcystectomy (laparacopic) either elective or emergency
ERCP
Abx
Drainage of gallbladder if empyema or unfit for surgery

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9
Q

Name three things you can see on US for cholecystitis?

A

CBD dilation, thickened gall bladder wall, gallstones

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10
Q

Should you perform ERCP/MRCP for cholecystitis?

A

NO! perform surgery

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11
Q

In elderly patients unfit for cholecystectomy, what option is there?

A

drain= cholecystostomy

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12
Q

What are the indications to perform MRCP?

A

If US shows no visible stones and there is evidence of obstruction (deranged LFTs)

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13
Q

What is the indication for ERCP?

A

if US shows stones within the common bile duct

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14
Q

What are signs and symptoms of acute cholecystitis?

A

constant dull ache RUQ or may be colicky, radiation to right shoulder or back, N/V, low grade temp, tenderness RUQ

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15
Q

What would blood tests show of someone who presenting with acute cholecystitis?

A

leukocytosis, possibly elevate bilirubin GGT, AlkP, however these can be normal

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16
Q

Differentials for RUQ pain

A 
GORD
acute pancreatitis
acute appendicitis
peptic ulcer disease
renal diseased
IBD
17
Q

Name one difference between the type of pain in biliary colic and acute cholecystitis?

A

pain is transient in colic whilst continuous in acute cholecystitis

18
Q

List three signs of acute cholecystitis

A

local peritonitis= positive murphy’s sign
raised WCC/CRP but no jaundice
thickened gall bladder wall

19
Q

What is the definitive treatment for ascending cholangitis?

A

ERCP! can do cholecystectomy if this doesn’t work/ in the future

20
Q

WHat is the definitive treatment of acute cholecystitis?

A

lap cholecystectomy

21
Q

Name three complications of ERCP

A

pancreatitis, haemorrhage, perforation

22
Q

List three signs of ascending cholangitis

A 
Obstructive jaundice
Raised ALP and bilirubin
Raised WCC/CRP
USS- dilated CBD
MRCP findings are diagnostic
23
Q

List three complications of lap cholecystectomy

A

CBD injury, bile leak, infection, bleeding, post-cholecystectomy syndrome

24
Q

What is post-cholcystectomy syndrome?

A

chronic diarrhoea. Can be benign and may resolve. Maybe worry about electrolyte derangement if chronic??

25
Q

List three signs of choledocolithiasis

A

proximal inflammation of biliary tree, jaundice, dilated hepatic bile ducts

26
Q

What is ascedning cholangitis?

A

choledocolithiasis + infection

27
Q

Charcot’s triad is always present in which disease?

A

ascending cholangitis

28
Q

42 y/o obese woman attends GP concerned about abdominal pain. It arose after eating fish and chips, began in epigastrium and has now settled in RUQ. She has also vomited several times. Most of her symptoms settled in 24 hours. On examinations she is mildly tender in the RUQ with no fever or jaundice. Diagnosis?

A

biliary colic

29
Q

43 year old man with known gallstones is on the waiting list for lap chole. He presents to ED with acute abdo pain fevers and vomiting. On examination he has jaundiced sclera and his abdomen is soft but tender in RUQ. His Obs are: HR 120, bp 90/65, temp 38.5, RR `18. What is the first thing you should do?

A

IV fluid resus

30
Q

A 46 year old woman had a lap chole 6 days ago for symptomatic gallstones. She presents to GP with reduced appetite and profuse diarrhoea and crampy abdo pain. Her obs are stable and on exam her abdomen is soft and wound site looks clean and dry. What should you do?

A

reassure and send home with worsening advice= post-cholecystectomy syndrome

31
Q

What is Mirizzi syndrome?

A

rare, large stone in GB extrinsically presses on common hepatic duct, causing obstructive jaundice- jaundice, fever, RUQ

Upper GI surgery (12 decks)

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