Gallstones

Question 1

What is meant by cholestasis?

Answer 1

Blockage of the flow of bile

Question 2

What is meant by cholelithiasis?

Answer 2

Presence of gallstones

Question 3

What are the risk factors for gallstones? How can this be remembered?

Answer 3

The four F’s:

• Fat
• Fair
• Female
• Forty

Question 4

How can gallstones present?

Answer 4

• Pain (biliary colic)
• The patient may present with a complication of gallstones, e.g.: obstructive jaundice, acute cholecystitis, acute cholangitis, pancreatitis

Question 5

What is meant by biliary colic?

Answer 5

Severe, squeezing pain in the RUQ which comes and goes in waves

Question 6

Why may a meal which is high in fat trigger biliary colic?

Answer 6

• Fat triggers the release of cholecystokinin (CCK) from the duodenum
• CCK triggers contraction of the gallbladder, which leads to biliary colic

Question 7

Describe the typical obstructive/cholestatic picture on LFTs

Answer 7

“Obstructive” or “cholestatic” picture:

• High bilirubin
• High ALP

Question 8

Describe the changes which may be present in the urine/stool in a patient with obstructive jaundice

Answer 8

• Dark urine

- Pale stools

Question 9

a) What is the first line investigation for diagnosing gallstones? What type of imaging may be used as an alternative in a patient who is overweight?
b) Which further investigation may also be performed if initial imaging is inconclusive?

Answer 9

a) USS. Alternative: CT scan

b) Magnetic Resonance Cholangio-Pancreatography (MRCP)

Question 10

Other than gallstones, which other cause of obstructive jaundice is important to consider?

Answer 10

Cancer of the head of the pancreas

Question 11

What is the name of the procedure used to clear stones in the bile ducts?

Answer 11

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

Question 12

Describe the management of patients presenting with symptoms or complications of gallstones

Answer 12

Cholecystectomy