Gallstones

Question 1

Gallstones, aka _______________, occur when hard mineral or fatty deposits form in the gallbladder

Answer 1

Cholelithiasis

Question 2

Define:

• cholelithiasis
• choledocholithiasis
• cholangitis
• cholecystitis

Answer 2

Define:

• cholelithiasis: gallstone (anywhere)
• choledocholithiasis: gallstone in the common bile duct
• cholangitis: inflammation of the biliary tract
• cholecystitis: inflammation of the gallbladder

Question 3

________________ is a general term that describes the presence of one or more stones in the gallbladder or in the bile duct, and the symptoms and complications that they may cause

Answer 3

Gallstone disease

Question 4

The majority of patients with gallstones remain ________________.

Answer 4

asymptomatic

Question 5

What are the symptoms of acute cholecystitis?

Answer 5

1. RUQ pain (acute onset, constant)
2. Nausea, vomiting
   May present with jaundice or other obstructive symptoms if stones are blocking the CBD or if inflammation of the cystic duct compresses the hepatic ducts (Mirizzi syndrome)

Question 6

What is Mirizzi syndrome?

Answer 6

common hepatic duct obstruction caused by extrinsic compression from an impacted tone in the cystic duct or infundibulum of the GB

Question 7

Do asymptomatic GB stones need to be treated?

Answer 7

Not unless symptoms develop

Question 8

What is the definitive treatment of symptomatic gallstones?

Answer 8

Surgical removal of GB by laparoscopic cholecystectomy

Question 9

What is the pharmacological management of gallstones?

Answer 9

Analgesia

• paracetamol or NSAIDs for mild-moderate pain
• IM diclofenac for severe pain OR IM opioid such as morphine or pethidine if diclofenac not suitable

*no evidence to support the use of ursodeoxycholic acid for the management of gallstone disease

Question 10

What are the symptoms of ascending cholangitis? (3/5)

Answer 10

Charcot’s triad:

1. RUQ pain
2. Fever
3. Jaundice

Reynold’s pentad:

4. Hypotension
5. Confusion