Gallstones Flashcards
Name four risk factors for gallstones
4 F’s
Female, fat, fourty, fertile
Name three types of gallstones
cholesterol, pigment, mixed
State four investigations for gallstones
LFTS, USS, MRCP, ERCP, HIDA scan
Which investigation is both diagnostic and therapeutic?
ERCP
Which four complications can arise from gallstone formation?
acute cholecystits ascending cholangitis biliary colic obstructive jaundice (choledocolethiasis) acute pancreatitis gallstone ileus
What are the symptoms of gallstone formation?
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
In which gallstone conditions would fever arise?
cholecytisis and cholangitis
What is the treatment for gallstones?
cholcystectomy (laparacopic) either elective or emergency
ERCP
Abx
Drainage of gallbladder if empyema or unfit for surgery
Name three things you can see on US for cholecystitis?
CBD dilation, thickened gall bladder wall, gallstones
Should you perform ERCP/MRCP for cholecystitis?
NO! perform surgery
In elderly patients unfit for cholecystectomy, what option is there?
drain= cholecystostomy
What are the indications to perform MRCP?
If US shows no visible stones and there is evidence of obstruction (deranged LFTs)
What is the indication for ERCP?
if US shows stones within the common bile duct
What are signs and symptoms of acute cholecystitis?
constant dull ache RUQ or may be colicky, radiation to right shoulder or back, N/V, low grade temp, tenderness RUQ
What would blood tests show of someone who presenting with acute cholecystitis?
leukocytosis, possibly elevate bilirubin GGT, AlkP, however these can be normal
Differentials for RUQ pain
GORD acute pancreatitis acute appendicitis peptic ulcer disease renal diseased IBD
Name one difference between the type of pain in biliary colic and acute cholecystitis?
pain is transient in colic whilst continuous in acute cholecystitis
List three signs of acute cholecystitis
local peritonitis= positive murphy’s sign
raised WCC/CRP but no jaundice
thickened gall bladder wall
What is the definitive treatment for ascending cholangitis?
ERCP! can do cholecystectomy if this doesn’t work/ in the future
WHat is the definitive treatment of acute cholecystitis?
lap cholecystectomy
Name three complications of ERCP
pancreatitis, haemorrhage, perforation
List three signs of ascending cholangitis
Obstructive jaundice Raised ALP and bilirubin Raised WCC/CRP USS- dilated CBD MRCP findings are diagnostic
List three complications of lap cholecystectomy
CBD injury, bile leak, infection, bleeding, post-cholecystectomy syndrome
What is post-cholcystectomy syndrome?
chronic diarrhoea. Can be benign and may resolve. Maybe worry about electrolyte derangement if chronic??
List three signs of choledocolithiasis
proximal inflammation of biliary tree, jaundice, dilated hepatic bile ducts
What is ascedning cholangitis?
choledocolithiasis + infection
Charcot’s triad is always present in which disease?
ascending cholangitis
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?
biliary colic
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?
IV fluid resus
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?
reassure and send home with worsening advice= post-cholecystectomy syndrome
What is Mirizzi syndrome?
rare, large stone in GB extrinsically presses on common hepatic duct, causing obstructive jaundice- jaundice, fever, RUQ
