Gallstones Flashcards
What is another term for gallstones?
Cholelithiasis
What are gallstones?
Small stones which form in the gall bladder
What are gallstones composed of?
Cholesterol and calcium
What are the brown soft stones composed of?
Calcium bilirubinate
What are the black hard stones composed of?
Pure pigment
What are the risk factors of gall stones?
Fat
Fertile
Female
Forty
How do gallstones present?
Colicky epigastric or RUQ pain
Pain is triggered by fatty meals
Nausea and vomiting
Does the pain radiate?
Yes to the shoulder tip
How long does the pain last?
30 minutes to 8 hours
What are the symptoms due to?
Biliary colic
Stone is obstructing the drainage of the gallbladder
What are the possible complications of gall stones?
Acute cholecystitis (inflammation of gall bladder) Acute cholangitis (infection of biliary tree) Obstructive jaundice Pancreatitis
What is Acute cholecystitis?
Inflammation of the gall bladder
What is Acute cholangitis?
Inflammation of the bile duct
What is pancreatitis?
Inflammation of the pancreas due to stones blocking the pancreatic duct
What is the gold standard investigation for gall stones?
Ultrasound
What other investigations are carried out for gallstones
Raised ALP
Raised bilirubin
ERCP
When would you carry out ERCP for gallstones?
When a history suggests gallstones but can’t see them on ultrasound
What is the management of gallstones if they are asymptomatic?
No treatment
What is the medical management of gallstones?
Morphine (IV)
Antiemetic- Domperidone, Metoclopramide
What is the surgical management of gallstones?
Laparoscopic cholecystectomy
What is the lifestyle management of gallstones?
Stop smoking- Major RF
What is biliary colic?
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.
What is biliary colic due to?
Gallstones passing through teh biliary tree
What are the main 4 risk factors for gallstones?
Fat
Female
Fertile: pregnancy
Forty
What are the other possible risk factors for gallstones?
diabetes mellitus
Crohn’s disease
rapid weight loss
drugs: combined oral contraceptive pill
What is the pain assciated with gallstones due to?
Gallbladder contracting against the stone in the cystic duct
What is not present in someone with biliary colic compared with other gallstone diseases?
No Fever
Liver function tests/inflammatory markers are normal
What are the possible complications of gallstones in the gallbladder?
Biliary colic
Cute or chronic cholecystitis
What are possible complications of gallstones in the biliary tree?
Obstructive jaundice
Pancreatitis
Cholangitis
What are the possible complications of gallstones in the duodenum?
Gallstone ileus
Gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum)
What sign is negative in someone with gallstones?
Murphy’s sign
What are the main features of acute cholecystitis?
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
