Gallstones

Question 1

What is a gallstone

Answer 1

Stone found in gallbladder
Made from bile pigment

Question 2

Most common type of gallstone

Answer 2

Cholesterol gall stone

Question 3

What are cholesterol gallstones caused by?

Answer 3

Diet/weight loss
Hormonal influence

Question 4

What are haemoglobin turnover gallstones caused by?

Answer 4

Haemolytic anaemia
Cirrhosis
Sickle cell

Question 5

Bililary anatomy

Answer 5

Gallbladder stores bile
When you eat food hits stomach then release CCK - causes gallbaldder to contract - gallbladder squeezes out bile going into duodenum - drains into D2 via ampulla of vater

Question 6

Symptoms of gallstone disease

Answer 6

Pain - colicky and peritoneal
Fever
Jaundice
Dietary upset

Main ones

Question 7

Main tests for gallstones

Answer 7

Alanine Transaminase -
bilirubin
amylase
us
mrcp
CT ABDOMEN

Question 8

What would ALT test indicate

Answer 8

if high then inflammation
liver damage

Question 9

first line for biliary disease

Answer 9

ULTRA SOUND SCAN
cheap

Question 10

what will bilirubin test show

Answer 10

blood levels of bilirubin
high if there is a blockage of the biliary tree

Question 11

treatment options for gallstones

Answer 11

• conservative management
• Radiologial drain
• ERCP
• cholescystectomy

Question 12

what does conservative management involve

Answer 12

analgesia
antibiotics

Question 13

benefits and consequences of conservative management

Answer 13

allow patients to ‘avoid’ surgery
50% remission in 6 months

Question 14

what does radiological drain involve

Answer 14

tube through skin into gall bladder

Question 15

benefits and consequences of radiological drain

Answer 15

relieves infection without surgery
in patient stay for 6+ weeks

Question 16

What we need to know to make a plan:

Answer 16

Where is the gallstone?
Does the patient have an infection? Do they have bad symptoms?
Does the patient need to have their gallbladder removed?

Question 17

presentation 1
Picked up during investigation for other problems.
No pain No fever
No jaundice
No examination findings
management ?

Answer 17

conservative management or do nothing

Question 18

presentation2
Pain, intermittent, crampy. Epigastric,
poorly localised
Worse after eating fatty foods No jaundice
No fever
Minimal RUQ tenderness
location, test and management

Answer 18

gall bladder
ultrasound
conservative management or discuss surgery

Question 19

presentation 3
Constant pain in RUQ/shoulder blade
Radiates AROUND side Pain on breathing in
May have low grade fever
RUQ tenderness/Murphy’s +

location, test and management?

Answer 19

gall bladder
US

Question 20

Pain, intermittent, crampy in epigastrium
Worse after eating fatty foods Dark urine/pale stools
No fever
No abdominal findings/mild RUQ discomfort
location, test and treatment?

Answer 20

common bile duct
us then mri
ercp