Gallstones Flashcards
What is cholelithiasis?
Gall stone disease
How are gall stones formed?
Bile contains cholesterol, bile pigments and phospholipids.
If the concentrations vary, different stones may form.
What are the different types of gall stones?
Pigment- small, irregular
Cholesterol- large, often solitary
Mixed- faceted, most common
What causes pigment stones?
Haemolysis
What causes cholesterol stones?
Female, Age, Obesity
What are the risk factors for gall stones?
Age
Gender
Parity
OCP
Cholesterol (Obesity, CF)
Pigment
Haemolytic anaemia
Bile infection (E.coli)
When do gallstones become symptomatic?
Cystic duct obstruction
Common bile duct obstruction
What is biliary colic?
Recurrent upper abdominal pain
Occurs when gallstone blocks biliary ducts, especially the cystic duct
Common after eating fatty food
What is the treatment for biliary colic?
Early laparoscopic cholecystectomy
What is acute cholecystitis?
Inflammation of gall bladder usually due to gallstones blocking the cystic duct
What is the difference between acute cholecystitis and biliary colic?
Inflammatory component
What are the symptoms of acute cholecystitis?
Continuous epigastric pain
Vomiting fever
Local peritonism
GB mass
What is the treatment for acute cholecystitis?
NBM
Pain relief
IVI
Antibiotics
Laparoscopic cholecystectomy
When is cholecystostomy done?
Drainage of gall bladder
Elderly or high risk patients
Acalculous cholecystitis
What is chronic cholecystitis?
Chronic inflammation of the gall bladder
What is the main symptom of chronic cholecystitis?
Flatulent dyspepsia
What is flatulent dyspepsia?
Vague abdominal discomfort
Distention
Nausea
Flatulence
Fat intolerance
What is the treatment for chronic cholecystitis?
Cholecystectomy
What are other presentations of gall stones?
Choledocholithiasis
Obstructive Jaundice
Cholangitis
Gallstone ileus
Pancreatitis
Mucocoele
Empyema
Mirizzi’s syndrome
Gall bladder necrosis
What is Choledocholithiasis?
Common bile duct stones
What is Obstructive jaundice?
Jaundice resulting from blockage of the bile ducts or abnormal retention of bile in the liver.
Pain
Dark urine
Pale stool
Pruritis
Steatorrhea
What is cholangitis?
Infection and inflammation of bile duct system
What is Charcot’s triad?
The symptoms of cholangitis:
- Jaundice
- RUQ pain with fever
- Rigors
What is gallstone ileus?
A stone erodes through the gallbladder into the duodenum; it may then obstruct the terminal ileum.
What is Bouveret’s syndrome?
Stone obstructs the duodenum
Much less common than gallstone ileus
What is mucocoele?
Obstructed gallbladder fills with mucus
What is empyema?
Obstructed gallbladder fills with pus
What is Mirizzi’s syndrome?
A stone in the gallbladder presses on the bile duct causing jaundice
Why is gallbladder necrosis rare?
Because of dual blood supply
What are the complications of gall stones in the gall bladder and cystic duct?
Biliary colic
Acute and chronic cholecystitis
Mucocoele
Empyema
Carcinoma
Mirizzi’s syndrome
What are the complications of gallstones in the bile duct?
Obstructive jaundice
Cholangitis
Pancreatitis
What are the complications of gallstones in the gut?
Gallstone ileus
