Gallstones Flashcards
What are the risk factors for gallstones?
Fat
Fair
Female
Forty
Fertile
How do patients with gallstones present?
May be completely asymptomatic
Typical symptom is biliary colic
- Severe, colicky epigastric or RUQ pain
- Triggered by meals
- Lasts between 30 minutes and 8 hours
- Associated with nausea and vomiting
Label the image
What causes biliary colic?
Stones temporarily obstruct gallbladder drainage, lodged at neck of gallbladder or in cystic duct, falls back into gallbladder relieving symptoms
Why do fatty meals exacerbate biliary colic?
CCK released from duodenum
CCK triggers gallbladder contraction causing biliary colic
What LFTs indicate hepatic damage?
Very raised ALT/AST
Slightly raised ALP
What LFTs indicate an obstructive picture?
Slightly raised ALT/AST
Very raised ALP
What is the first-line investigation for gallstones?
Ultrasound
What is MRCP?
Magnetic resonance cholangio-pancreatography
MRI of the biliary system
Very sensitive and specific for biliary disease
Typically used to investigate further if USS does not show stones in duct but if there is duct dilatation or raised bilirubin
What is ERCP?
Endoscopic retrograde cholangio-pancreatography
Insertion of an endoscope to the duodenum and the sphincter of Oddi
Used to clear stones in bile ducts
What does ERCP allow the operator to do?
Inject contrast and take X-rays
Sphincterotomy
Clear stones from ducts
Stent insertion
Tumour biopsies
What are the key complications of ERCP?
Excessive bleeding
Cholangitis
Pancreatitis
What are CTs used for in gallstones?
Looking for differential diagnoses
What is the management of gallstones?
Asymptomatic- conservatively
Symptomatic- cholecystectomy
When is cholecystectomy indicated?
- Symptomatic of gallstones
- Complications arise due to gallstones
