Gallstones

Question 1

What is cholelithiasis?

Answer 1

Gall stone disease

Question 2

How are gall stones formed?

Answer 2

Bile contains cholesterol, bile pigments and phospholipids.
If the concentrations vary, different stones may form.

Question 3

What are the different types of gall stones?

Answer 3

Pigment- small, irregular
Cholesterol- large, often solitary
Mixed- faceted, most common

Question 4

What causes pigment stones?

Answer 4

Haemolysis

Question 5

What causes cholesterol stones?

Answer 5

Female, Age, Obesity

Question 6

What are the risk factors for gall stones?

Answer 6

Age
Gender
Parity
OCP
Cholesterol (Obesity, CF)
Pigment
Haemolytic anaemia
Bile infection (E.coli)

Question 7

When do gallstones become symptomatic?

Answer 7

Cystic duct obstruction
Common bile duct obstruction

Question 8

What is biliary colic?

Answer 8

Recurrent upper abdominal pain
Occurs when gallstone blocks biliary ducts, especially the cystic duct
Common after eating fatty food

Question 9

What is the treatment for biliary colic?

Answer 9

Early laparoscopic cholecystectomy

Question 10

What is acute cholecystitis?

Answer 10

Inflammation of gall bladder usually due to gallstones blocking the cystic duct

Question 11

What is the difference between acute cholecystitis and biliary colic?

Answer 11

Inflammatory component

Question 12

What are the symptoms of acute cholecystitis?

Answer 12

Continuous epigastric pain
Vomiting fever
Local peritonism
GB mass

Question 13

What is the treatment for acute cholecystitis?

Answer 13

NBM
Pain relief
IVI
Antibiotics
Laparoscopic cholecystectomy

Question 14

When is cholecystostomy done?

Answer 14

Drainage of gall bladder
Elderly or high risk patients
Acalculous cholecystitis

Question 15

What is chronic cholecystitis?

Answer 15

Chronic inflammation of the gall bladder

Question 16

What is the main symptom of chronic cholecystitis?

Answer 16

Flatulent dyspepsia

Question 17

What is flatulent dyspepsia?

Answer 17

Vague abdominal discomfort
Distention
Nausea
Flatulence
Fat intolerance

Question 18

What is the treatment for chronic cholecystitis?

Answer 18

Cholecystectomy

Question 19

What are other presentations of gall stones?

Answer 19

Choledocholithiasis
Obstructive Jaundice
Cholangitis
Gallstone ileus
Pancreatitis
Mucocoele
Empyema
Mirizzi’s syndrome
Gall bladder necrosis

Question 20

What is Choledocholithiasis?

Answer 20

Common bile duct stones

Question 21

What is Obstructive jaundice?

Answer 21

Jaundice resulting from blockage of the bile ducts or abnormal retention of bile in the liver.

Pain
Dark urine
Pale stool
Pruritis
Steatorrhea

Question 22

What is cholangitis?

Answer 22

Infection and inflammation of bile duct system

Question 23

What is Charcot’s triad?

Answer 23

The symptoms of cholangitis:
- Jaundice
- RUQ pain with fever
- Rigors

Question 24

What is gallstone ileus?

Answer 24

A stone erodes through the gallbladder into the duodenum; it may then obstruct the terminal ileum.

Question 25

What is Bouveret’s syndrome?

Answer 25

Stone obstructs the duodenum
Much less common than gallstone ileus

Question 26

What is mucocoele?

Answer 26

Obstructed gallbladder fills with mucus

Question 27

What is empyema?

Answer 27

Obstructed gallbladder fills with pus

Question 28

What is Mirizzi’s syndrome?

Answer 28

A stone in the gallbladder presses on the bile duct causing jaundice

Question 29

Why is gallbladder necrosis rare?

Answer 29

Because of dual blood supply

Question 30

What are the complications of gall stones in the gall bladder and cystic duct?

Answer 30

Biliary colic
Acute and chronic cholecystitis
Mucocoele
Empyema
Carcinoma
Mirizzi’s syndrome

Question 31

What are the complications of gallstones in the bile duct?

Answer 31

Obstructive jaundice
Cholangitis
Pancreatitis

Question 32

What are the complications of gallstones in the gut?

Answer 32

Gallstone ileus