gallstones

Question 1

what are common presentations of gallstones?

Answer 1

• asymptomatic
• cholestatic liver function tests- raised ALP and GGT
• indigestion after fatty meals
• biliary colic
• acute cholecystitis-> fever, RUQ tenderness, pain,
  jaundice
• ascending cholangitis (virchows triad-> fever (rigors), RUQ pain and jaundice
• Acute pancreatitis

Question 2

what are uncommon presentations of gallstones?

Answer 2

• obstructive jaundice without symptoms
• gallstone iléus ->.small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine. Such a gallstone enters the bowel via a cholecysto-enteric fistula.

Question 3

why can gallstones lead to pale, greasy stools and dark urine?

Answer 3

• the gallstone will block the flow of bile form the common bile duct to the duodenum and so the conjugated bile is unable to turn into urobilinogen act and give the stools a dark colour
• since the bile is not moving into the duodenum it will be reabsorbed by the blood and go to the liver and kidneys- in the kidneys it will be excreted in the urine, giving the urine a dark colour

Question 4

why can obstructive jaundice cause pruritus?

Answer 4

obstruction of the common bile duct can cause a build in the common bile duct and an increase in pressure

this will cause the bile duct to become leaky and bile, bile salts and cholesterol will leak out- this causes the skin to become itchy

Question 5

what is post cholecystectomy syndrome?

Answer 5

Diarrhoea
Indigestion
Epigastric or right upper quadrant pain and discomfort
Nausea
Intolerance of fatty foods
Flatulence

Question 6

what are the key investigations for a cholecytisis?

Answer 6

1. USS- obstructive gallstones will show a dilated bile duct >6 mm
2. MRCP- non invasive imaging of the billiard system
3. ERCP: imaging and removal of the gallstone in the bile duct
4. CT- to look for non-gallstone causes of the obstruction such as a tumour of the head of the pancreas

Question 7

what is the triad associated with gallstone illeus?

Answer 7

triad of of findings on an abdominal radiograph= riggers triad:

(1) small bowel obstruction,
(2) a gallstone outside the gallbladder,
(3) air in the bile ducts (pneumobillia)

Question 8

what is the cause of gallstone ileaus?

Answer 8

caused by a cholecystoenteric fistula- which can be formed by a big stone- from the gallbladder to the duodenum
the big stone erodes the gallbladder wall and causes bowel obstruction when it gets to the small bowel