Gallstones

Question 1

What is another term for gallstones?

Answer 1

Cholelithiasis

Question 2

What are gallstones?

Answer 2

Small stones which form in the gall bladder

Question 3

What are gallstones composed of?

Answer 3

Cholesterol and calcium

Question 4

What are the brown soft stones composed of?

Answer 4

Calcium bilirubinate

Question 5

What are the black hard stones composed of?

Answer 5

Pure pigment

Question 6

What are the risk factors of gall stones?

Answer 6

Fat
Fertile
Female
Forty

Question 7

How do gallstones present?

Answer 7

Colicky epigastric or RUQ pain
Pain is triggered by fatty meals
Nausea and vomiting

Question 8

Does the pain radiate?

Answer 8

Yes to the shoulder tip

Question 9

How long does the pain last?

Answer 9

30 minutes to 8 hours

Question 10

What are the symptoms due to?

Answer 10

Biliary colic

Stone is obstructing the drainage of the gallbladder

Question 11

What are the possible complications of gall stones?

Answer 11

Acute cholecystitis (inflammation of gall bladder)
Acute cholangitis (infection of biliary tree) 
Obstructive jaundice 
Pancreatitis

Question 12

What is Acute cholecystitis?

Answer 12

Inflammation of the gall bladder

Question 13

What is Acute cholangitis?

Answer 13

Inflammation of the bile duct

Question 14

What is pancreatitis?

Answer 14

Inflammation of the pancreas due to stones blocking the pancreatic duct

Question 15

What is the gold standard investigation for gall stones?

Answer 15

Ultrasound

Question 16

What other investigations are carried out for gallstones

Answer 16

Raised ALP
Raised bilirubin
ERCP

Question 17

When would you carry out ERCP for gallstones?

Answer 17

When a history suggests gallstones but can’t see them on ultrasound

Question 18

What is the management of gallstones if they are asymptomatic?

Answer 18

No treatment

Question 19

What is the medical management of gallstones?

Answer 19

Morphine (IV)

Antiemetic- Domperidone, Metoclopramide

Question 20

What is the surgical management of gallstones?

Answer 20

Laparoscopic cholecystectomy

Question 21

What is the lifestyle management of gallstones?

Answer 21

Stop smoking- Major RF

Question 22

What is biliary colic?

Answer 22

Pain in the right upper abdomen that may radiate up to the shoulder seen typically after eating a large, fatty meal that causes contraction of the gallbladder.

Question 23

What is biliary colic due to?

Answer 23

Gallstones passing through teh biliary tree

Question 24

What are the main 4 risk factors for gallstones?

Answer 24

Fat
Female
Fertile: pregnancy
Forty

Question 25

What are the other possible risk factors for gallstones?

Answer 25

diabetes mellitus
Crohn’s disease
rapid weight loss
drugs: combined oral contraceptive pill

Question 26

What is the pain assciated with gallstones due to?

Answer 26

Gallbladder contracting against the stone in the cystic duct

Question 27

What is not present in someone with biliary colic compared with other gallstone diseases?

Answer 27

No Fever
Liver function tests/inflammatory markers are normal

Question 28

What are the possible complications of gallstones in the gallbladder?

Answer 28

Biliary colic
Cute or chronic cholecystitis

Question 29

What are possible complications of gallstones in the biliary tree?

Answer 29

Obstructive jaundice
Pancreatitis
Cholangitis

Question 30

What are the possible complications of gallstones in the duodenum?

Answer 30

Gallstone ileus
Gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum)

Question 31

What sign is negative in someone with gallstones?

Answer 31

Murphy’s sign

Question 32

What are the main features of acute cholecystitis?

Answer 32

Right upper quadrant/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated)
Fever
Nausea and vomiting
Right upper quadrant tenderness
Murphy’s sign positive