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Finals: Surgery > Gallstones > Flashcards

Gallstones Flashcards

1
Q

What is the laymans term for Cholelithiasis

A

Gallstones

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2
Q

Where are Cholelithiasis i.e. gallstones formed?

A

Formed within the gallbladder or bile duct

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3
Q

What is the function of the gallbladder

A

Stores and concentrates bile

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4
Q

What secretes biles

A

Hepatocytes of the liver

Secretes bile into the biliary circulation

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5
Q

What are the 3 components of bile

A

Bile pigments – product of haemoglobin metabolism

Phospholipid

Cholesterol

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6
Q

Bile pigments is the product of _____ metabolism

A

Haemoglobin

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7
Q

Define Acute cholecystitis

A

Inflammation of the gallbladder

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8
Q

Define Acute cholangitis

A

inflammation of the biliary tree

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9
Q

Gallstones are classified based on their consistency.

Name the 3 types of gallstones

A

Cholesterol stones

Pigment stones

Mixed stones

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10
Q

Gallstones are classified based on their consistency: (1) Pigment; (2) Cholesterol; (3) Mixed

Describe the consistency of pigment stones

A

Composed purely of bile pigments

The result of excess bile pigments production

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11
Q

Gallstones are classified based on their consistency: (1) Pigment; (2) Cholesterol; (3) Mixed

Describe the consistency of Cholesterol stones

A

Composed purely of cholesterol

Result of excess cholesterol production

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12
Q

Gallstones are classified based on their consistency: (1) Pigment; (2) Cholesterol; (3) Mixed

Describe the consistency of mixed stones

A

Comprised of both cholesterol and bile pigments

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13
Q

Name the three events that if one of them occurs gallstones are formed as a result

A

Cholesterol supersaturation

Biliary stasis

Increased secretion of bilirubin

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14
Q

Name the 5 risk factors for gallstones

A

Five F’s mnemonic:

F – Female

F – Fair

F – Fertile

F – Forty

F – Fat

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15
Q

What is the mainstay symptom of gallstones

A

Biliary colic - colicky pain in the RUQ

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16
Q

What kind of jaudice is associated with gallstones

A

Obstructive jaundice (if the stone blocks the ducts)

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17
Q

Obstruction of the biliary tree prevents bile from being secreted into the GI tract.

The result is

a) Pale or dark urine
b) Pale or dark stools

A

a) Dark urine
b) Pale stools

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18
Q

What causes biliary colic

A

Caused by stones temporarily obstructing drainage of the gallbladder

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19
Q

Biliary colic is caused by stones temporarily obstructing drainage of the gallbladder.

Where can the stones get stuck?

A

Lodged at the neck of the gallbladder or in the cystic duct

When the stone falls back into the gallbladder the symptoms resolve

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20
Q

Describe the symptoms of biliary colic

A

Severe, colicky epigastric or right upper quadrant pain

Often triggered by meals (particularly high fat meals)

Lasting between 30 minutes and 8 hours

May be associated with nausea and vomiting

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21
Q

Why do high fat meals stimulate biliary colic?

A

Fat entering the digestive system causes cholecystokinin (CCK) secretion from the duodenum

CCK triggers contraction of the gallbladder, which can cause the stone to get lodged in the gallbladder neck causing biliary colic

22
Q

Fat entering the digestive system causes secretion of which hormone from the duodenum

A

Cholecystokinin (CCK)

23
Q

The complications of gallstones vary depending on the location of the gallstone.

What complications are associated with a gallstone in the gallbladder

A

Biliary colic

Acute cholecystitis

Gallbladder empyema (pus within the gallbladder)

24
Q

The complications of gallstones vary depending on the location of the gallstone.

What complications are associated with a gallstone in the common bile duct

A

Obstructive jaundice

Acute cholangitis

Acute pancreatitis

25
Q

The complications of gallstones vary depending on the location of the gallstone.

What complications are associated with a gallstone in the small intestine

A

Gallbladder ileus (stone impacting the terminal ileum) causing small bowel obstruction

26
Q

What is Mirizzi Syndrome

A

Gallstone in the Hartmanns pouch or in the cystic duct causing compression of the adjacent common hepatic duct.

Result is obstructive jaundice.

27
Q

What is Gallbladder empyema

A

Gallbladder has become filled with pus

Often leading to sepsis.

Similar clinical picture to acute cholecystitis

28
Q

What are the symptoms of acute cholecystitis

A

Acute cholecystitis refers to inflammation of the gallbladder

RUQ, fevers, malaise

29
Q

What features will be present for acute cholecystitis on examination

A

Acute cholecystitis refers to inflammation of the gallbladder

Tenderness

Localised guarding may be present

30
Q

What features will be present for acute cholecystitis on blood tests

A

Acute cholecystitis refers to inflammation of the gallbladder

Raised inflammatory markers (WCC + CRP)

Normal LFTs

31
Q

What features will be present for acute cholecystitis on ultrasound

A

Acute cholecystitis refers to inflammation of the gallbladder

Thickened wall of the gallbladder

32
Q

What are the symptoms of acute cholangitis

A

acute cholangitis refers to inflammation of the biliary tree

RUQ, fevers, malaise, confusion

33
Q

What features will be present for acute cholangitis on examination

A

acute cholangitis refers to inflammation of the biliary tree

Tenderness

Jaundice

34
Q

What features will be present for acute cholangitis on blood tests

A

acute cholangitis refers to inflammation of the biliary tree

Raised inflammatory markers (CRP, WCC)

Raised bilirubin, ALP and ALT

35
Q

What are some of the features of acute cholangitis on ultrasound

A

acute cholangitis refers to inflammation of the biliary tree

CBD stone (although USS sensitivity is low for these stones)

Duct dilatation

36
Q

What are the classical symptoms of acute pancreatitis

A

Acute pancreatitis refers to inflammation of the pancreas

Epigastric pain radiating to the back

37
Q

What is the key feature of acute pancreatitis on examination

A

Acute pancreatitis refers to inflammation of the pancreas

Epigastric tenderness

38
Q

What features will be present for acute pancreatitis on blood tests

A

Raised amylase = pancreatitis

39
Q

What is the gold standard investigation for gallstones

A

Ultrasound

40
Q

Ultrasound is the most sensitive initial imaging modality for gallstones.

Name some of the limitations of ultrasound?

A

Ultrasound is limited by:

Patient’s weight

Gaseous bowel obstructing the view

Discomfort from the probe

41
Q

What is the imaging modality used for biliary tree disease

A

Biliary tree disease such as stones in the bile duct and malignancy

Magnetic Resonance Cholangio-Pancreatography (MRCP) - MRI scan

42
Q

Iif the ultrasound scan does not show stones in the duct, but there is bile duct dilatation or raised bilirubin.

What is the diagnosis

A

Obstruction

43
Q

Magnetic Resonance Cholangio-Pancreatography (MRCP) produces a detailed image of the biliary system.

What kind of imaging modality is it:

a) CT
b) MRI
c) X-ray
d) Ultrasound

A

b) MRI

44
Q

What is the main indication for Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

A

Clear stones in the bile ducts.

45
Q

What is involved in Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

A

Involves inserting an endoscope down the oesophagus, past the stomach, to the duodenum and the sphincter of Oddi

Can inject contrast and take x-rays to visualise the biliary system and diagnose pathology e.g., stones or strictures

Can perform a sphincterotomy on the sphincter of Oddi if it is dysfunctional (blocking flow)

Can clear stones from the ducts

46
Q

Name the 3 potential complications of ERCP

A

Excessive bleeding

Cholangitis (infection in the bile ducts)

Pancreatitis

47
Q

How do you manage asymptomatic patients with gallstones

A

Conservatively with no intervention required

48
Q

How do you manage symptomatic patients or those with complications

A

Cholecystectomy

49
Q

Define Cholecystectomy

A

Refers to the surgical removal of the gallbladder

50
Q

Laparoscopic cholecystectomy (keyhole surgery) is preferred to open cholecystectomy (with a right subcostal “Kocher” incision).

Why?

A

It has less complications and a faster recovery

51
Q

Name some of the complications of cholecystectomy

A

Bleeding, infection, pain, and scars

Damage to the bile duct including leakage and strictures

Stones left in the bile duct

Damage to the bowel, blood vessels or other organs

Anaesthetic risks

Venous thromboembolism (deep vein thrombosis or pulmonary embolism)

Post-cholecystectomy syndrome

52
Q

What is post-cholecystectomy syndrome

A

Refers to a group of non-specific symptoms that can occur after a cholecystectomy

Symptoms often improve with time.

Symptoms include:

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

Finals: Surgery (10 decks)

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