Gallstones Flashcards
What is a gallstone
Stone found in gallbladder
Made from bile pigment
Most common type of gallstone
Cholesterol gall stone
What are cholesterol gallstones caused by?
Diet/weight loss
Hormonal influence
What are haemoglobin turnover gallstones caused by?
Haemolytic anaemia
Cirrhosis
Sickle cell
Bililary anatomy
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
Symptoms of gallstone disease
Pain - colicky and peritoneal
Fever
Jaundice
Dietary upset
Main ones
Main tests for gallstones
Alanine Transaminase -
bilirubin
amylase
us
mrcp
CT ABDOMEN
What would ALT test indicate
if high then inflammation
liver damage
first line for biliary disease
ULTRA SOUND SCAN
cheap
what will bilirubin test show
blood levels of bilirubin
high if there is a blockage of the biliary tree
treatment options for gallstones
- conservative management
- Radiologial drain
- ERCP
- cholescystectomy
what does conservative management involve
analgesia
antibiotics
benefits and consequences of conservative management
allow patients to ‘avoid’ surgery
50% remission in 6 months
what does radiological drain involve
tube through skin into gall bladder
benefits and consequences of radiological drain
relieves infection without surgery
in patient stay for 6+ weeks
What we need to know to make a plan:
Where is the gallstone?
Does the patient have an infection? Do they have bad symptoms?
Does the patient need to have their gallbladder removed?
presentation 1
Picked up during investigation for other problems.
No pain No fever
No jaundice
No examination findings
management ?
conservative management or do nothing
presentation2
Pain, intermittent, crampy. Epigastric,
poorly localised
Worse after eating fatty foods No jaundice
No fever
Minimal RUQ tenderness
location, test and management
gall bladder
ultrasound
conservative management or discuss surgery
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?
gall bladder
US
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?
common bile duct
us then mri
ercp
