Gallstones Flashcards
What are gallstones?
Small stones formed in gall bladder
What are gallstones formed from?
Concentrated bile in bile duct
What is Cholestasis?
Blockage to flow of bile
What is Cholelithiasis?
Gallstones
What is Choledocholithiasis?
Gallstones in bile duct
What is Cholecystitis?
Inflamm of gall bladder
What is Cholangitis?
Inflamm of bile ducts
What is Gallbladder empyema?
Pus in gallbladder
What is Cholecystectomy?
Surgical removal of gallbladder
What is Cholecystostomy?
Inserting drain into gallbladder
What are the different types of stones? (3 things)
- Pigment stones
- Cholesterol stones
- Mixed stones
What are the characteristics of Pigment stones? (3 things)
- Small
- Irregular
- Friable
What are the causes of Pigment stones?
Haemolysis
What are the characteristics of Cholesterol stones? (2 things)
- Large
- Often solitary
What are the causes of Cholesterol stones? (3 things)
- Female
- Age
- Obesity
What are the characteristics of Mixed stones?
Faceted (has many flattened sides)
What are Mixed stones made up of? (3 things)
- Calcium salts
- Pigment
- Cholesterol
What are the risk factors of gallstones? (4 things)
- Fat
- Fair
- Female
- Forty
4 F’s
What are the CF of gallstones? (2 things)
- Can be asymptomatic
- Biliary colic (severe colicky epigastric / RUQ pain) (typical symptom of gallstones)
What is Biliary colic? (3 things)
- Severe colicky Epigastric / RUQ pain
- Radiates to back
- (+/- jaundice)
When are gallstones symptomatic, aka show biliary colic? (2 things)
- Cystic duct obstruction
- Passed into Common bile duct
What is Biliary colic triggered by?
Meals (esp high fat)
How long does Biliary colic last?
30 mins – 8hrs
What can Biliary colic assoc w?
Nausea + vomiting
What is Biliary colic caused by?
Stones temporarily obst gallbladder drainage
Why are gallstone patients asked to avoid fatty foods?
To prevent cholecystokinin (CCK) release
What is the mechanism that fatty meals causes biliary colic? (3 things)
- Person eats fatty food
- CCK released from duodenum
- CCK triggers contraction of gallbladder –> biliary colic
What investigations should be done for biliary colic? (3 things)
- Urinalysis
- CXR
- ECG
What is the management of Biliary Colic? (4 things)
- Analgesia
- Rehydrate
- NBM
- Elective laparoscopic cholecystectomy
What investigations should be done for gallstones? (5 things)
- LFTs
- US
- MRCP
- ERCP
- CT
What may LFTs be saying in gallstones? (3 things)
- Raised bilirubin
- Raised ALP
- Raised ALT + AST
Why may bilirubin be raised in gallstones? (2 steps)
- Gallstone obstructing bile duct
- Stops normal drainage of bilirubin from liver –> bile ducts –> intestines
What represents an obstruction to flow within the biliary system? (3 things)
- Raised bilirubin (jaundice)
- Pale stools
- Dark urine
When is a raised ALP most probs assoc w biliary obstruction? (2 things)
In presence of:
- RUQ
- Jaundice
What is the first-line investigation tool for gallstone symptoms?
US
What are US for gallstones limited by? (3 things)
- Patients weight
- Gaseous bowel obstructing view
- Discomfort from probe
What can US help you identify in sus gallstones? (4 things)
- Gallstones in gallbladder / ducts
- Bile duct dilatation
- Acute cholecystitis
- Pancreas + pancreatic duct
What will you see on an US in acute cholecystitis? (3 things)
- Thickened gallbladder wall
- Stones / sludge in gallbladder
- Fluid around gallbladder
When is MRCP used in gallstones?
US shows no stones in duct, but bile duct dilatation / raised bilirubin suggests obstruction
What does MRCP show?
Detailed image of biliary system
What is ERCP?
Inserting endoscope down oesophagus –> stomach –> duodenum + opening of Common bile duct (sphincter of Oddi)
What is the main indication of ERCP?
Clear stones in bile ducts
What does ERCP allow us to do? (5 things)
- Inject contrast + take XR to visualize biliary system to make diagnosis
- Perform sphincterotomy on sphincter of Oddi (if blocking flow)
- Clear stones from ducts
- Insert stents to improve bile duct drainage
- Take biopsies of tumour
What are the complications of ERCP? (3 things)
- Bleeding
- Cholangitis (inf of bile duct)
- Pancreatitis
What is the use of CT in gallstones? (2 things)
- Not useful when looking at biliary system / gallstones
- Used to check for any DD / complications / abscesses
What are some DD of gallstones? (5 things)
- PUD
- Gastroenteritis
- Acute appendicitis
- Pancreatitis
- Nephrolithiasis (kidney stones)
How can asymptomatic gallstone patients be managed?
Conservatively
How are patients with symptoms / complications of gallstones managed?
Cholecystectomy (surgical removal of gallbladder)
What are the complications of Cholecystectomy? (6 things)
- Damage to bile duct (leakage / strictures)
- Stones left in bile duct
- Bleeding
- Infection
- Damage to bowel / blood vessels / other organs
- DVT / PE
What are the complications of gallstones? (5 things)
- Acute cholecystitis (inflamm of gallbladder)
- Acute cholangitis (inflamm of bile ducts)
- Obst jaundice (if stones block ducts)
- Pancreatitis
- Gallstone ileus
What is the test / sign you look for in Acute Cholecystitis?
Murphy’s sign
How do you test for Murphy’s sign? (4 steps)
- Place hand in RUQ + apply pressure
- Ask pt to take a deep breath in
- Gallbladder moves downward @ insp n touches ur hand
- Stimulating inflamm gallbladder –> acute pain + sudden stopping of insp
How should a patient with Acute cholecystitis be managed? (6 things)
- NBM
- IV fluids
- Abx
- NG tube (if vomiting)
- ERCP to remove stones
- Cholecystectomy
What are the complications of Acute cholecystitis? (4 things)
- Sepsis
- Gallbladder empyema (pus in gallbladder)
- Gangrenous gallbladder
- Perforation
How do you differentiate between Biliary colic, Acute Cholecystitis, and Cholangitis?
- Biliary colic: RUQ pain
- Cholecystitis: RUQ pain + Fever + Raised WCC
- Cholangitis: RUQ pain + Fever + Raised WCC + Jaundice
