Gallstones Flashcards
What are gallstones?
They are defined as a condition in which there is formation of stones within the gallbladder
These stones consist of hardened deposits of digestive fluid
What two materials do gallstones usually consist of?
Cholesterol
Bilirubin
What is the term used to refer to gallstones that consist of bilirubin?
Pigment gallstones
What are the twelve risk factors associated with gallstones?
Older Age > 40
Female Gender
Family History
Obesity
Pregnancy
Liver Cirrhosis
Primary Sclerosing Cholangitis
Crohn’s Disease
Irritable Bowel Syndrome
Diabetes Mellitus
Sudden Weight Loss
Drug Administration
What five drugs are associated with gallstones?
Combined contraceptive pill
Hormone replacement therapy
Ceftriaxone
Fenofibrate
Cholestyramine
What pneumonic can be used to remember the main risk factors of gallstones?
5 Fs
Fat
Female
Fertile
Forty
Fair
In general, when how gallstones present?
Asymptomatically
They become symptomatic obstruction of the bile ducts has occurred (biliary colic)
What are the six clinical features of gallstones?
Colicky Right Upper Quadrant Pain
Jaundice
Diarrhoea
Fever
Nausea & Vomiting
Tachycardia
What usually worsens the right upper quadrant pain associated with gallstones? What term is used to describe this?
Fatty foods
Postprandial
What are the three investigations used to diagnose gallstones?
Blood Tests
Ultrasound Scan
Magnetic Resonance Cholangiopancreatography (MRCP)
What are the five blood test results indicative of gallstones?
Increased AST Levels
Increased ALT Levels
Increased ALP Levels
Increased Bilirubin Levels
Increased Cholesterol Levels
What is the gold standard investigation used to diagnose gallstones?
Ultrasound scan
What are the two features of gallstones on ultrasound scans?
Echogenic Lesions
Rolling Stone Sign
What is the rolling stone sign?
It is when a change of patient position causes gravity dependent movement of the stone
What is MRCP?
It is a specialised MRI scan that produces detailed images of the hepatobiliary and pancreatic systems
When are MRCPs used to investigate gallstones?
Those who present with a suggestive history of gallstones, however, produce negative ultrasound scan results
When is management of gallstones recommended?
In cases of asymptomatic gallstones within the gallbladder, management options are not required
However, in cases where the asymptomatic gallstones are present within the common bile duct there is an increased complication risk and therefore management should be considered
What is the pharmacological management option of gallstones?
Bile Acids
Name a bile acid used to manage gallstones
Ursodeoxycholic acid (UDCA)
How do bile acids manage gallstones?
They are used to regulate cholesterol levels and therefore dissolve cholesterol containing gallstones
When are bile acids used to manage gallstones?
When individuals are unfit for surgery
Why is pharmacological management of gallstones generally not recommended?
They are rarely effective
They require around two years of treatment to produce results
In which two patient groups is UCDA contraindicated?
Pregnant
Breastfeeders
What are the two surgical management options of gallstones?
Laparoscopic Cholecystectomy
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is the gold standard management option for gallstones?
Laparoscopic Cholecystectomy
What is laparoscopic cholecystectomy?
It involves surgical removal of the gallbladder, following which bile will flow directly from the liver into the small bowel
What incision is used in cholecystectomy?
Kocher’s
When should laparoscopic cholecystectomy be conducted electively?
In cases where there are no features of acute cholecystitis
When should laparoscopic cholecystectomy be conducted urgently?
In cases where there is development of acute cholecystitis
What are the two complications associated with laparoscopic cholecystectomy?
Biliary leak
Gallstones in common bile duct
What is the most common complication associated with laparoscopic cholecystectomy?
Biliary leak
What are the two clinical features associated with biliary leak?
Right upper quadrant tenderness
Bilious fluid in the intra-abdominal drain
What is ERCP?
It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum
In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken
How is ERCP used to manage gallstones?
It can be used to remove gallstones from the bile duct
In some cases, a stent is then inserted into the bile duct to prevent reoccurrence
What are the six complications associated with gallstones?
Biliary Colic
Acute Cholecystitis
Gallbladder Abscess
Ascending Cholangitis
Gallstone Ileus
Acute Pancreatitis
What is biliary colic?
It occurs when the bile ducts become obstructed
What five blood test results indicate biliary colic?
Normal ALP Levels
Normal AST Levels
Normal ALT Levels
Normal yGT Levels
Normal CRP Levels
