Gallstones

Question 1

What is biliary colic?

Answer 1

Biliary colic is an acute, painful spasm of the gallbladder wall due to a gallstone temporarily blocking the neck of the gallbladder, cystic duct, or common bile duct.

Question 2

What are the typical symptoms of biliary colic?

Answer 2

Sudden onset of severe, colicky pain in the right upper quadrant, which may radiate to the epigastric region, right shoulder, or interscapular region.

Question 3

What usually precedes an episode of biliary colic?

Answer 3

Consumption of a fatty meal.

Question 4

What is the aetiology of biliary colic?

Answer 4

Temporary obstruction of bile flow due to gallstones blocking the neck of the gallbladder, cystic duct, or common bile duct.

Question 5

What is the pathophysiology of biliary colic?

Answer 5

Obstruction increases pressure in the gallbladder, leading to contraction against the blockage and resulting in visceral pain.

Question 6

What is acute cholecystitis?

Answer 6

Acute cholecystitis is the inflammation of the gallbladder, typically due to persistent obstruction by a gallstone.

Question 7

What are common symptoms of acute cholecystitis?

Answer 7

Severe, constant right upper quadrant pain, fever, nausea, vomiting, and positive Murphy’s sign.

Question 8

What is the primary cause of acute cholecystitis?

Answer 8

Persistent obstruction of the cystic duct by a gallstone, leading to gallbladder inflammation.

Question 9

What clinical examination finding is indicative of acute cholecystitis?

Answer 9

Positive Murphy’s sign: pain upon palpation of the right upper quadrant during deep inspiration.

Question 10

What is acute cholangitis?

Answer 10

Acute cholangitis is a bacterial infection of the biliary tree, often due to bile duct obstruction.

Question 11

What are the hallmark symptoms of acute cholangitis?

Answer 11

Charcot’s triad: right upper quadrant pain, fever, and jaundice.

Question 12

What is the most common cause of acute cholangitis?

Answer 12

Bile duct obstruction, frequently due to gallstones.

Question 13

What is Charcot’s triad?

Answer 13

A combination of right upper quadrant pain, fever, and jaundice, indicative of acute cholangitis.

Question 14

What is the initial imaging modality for suspected biliary pathology?

Answer 14

Ultrasound of the abdomen.

Question 15

What blood tests are commonly elevated in acute cholangitis?

Answer 15

Elevated white cell count, C-reactive protein, and liver function tests, particularly alkaline phosphatase and bilirubin.

Question 16

What is the first-line treatment for acute cholecystitis?

Answer 16

Supportive care with intravenous fluids, antibiotics, and analgesia, followed by cholecystectomy.

Question 17

What is the definitive treatment for biliary colic?

Answer 17

Elective cholecystectomy to remove the gallbladder and prevent recurrence.

Question 18

What is the recommended management for acute cholangitis?

Answer 18

Intravenous antibiotics and biliary drainage, often via endoscopic retrograde cholangiopancreatography (ERCP).

Question 19

What is the role of ERCP in biliary diseases?

Answer 19

ERCP is used for both diagnostic and therapeutic purposes, including biliary drainage and stone removal.

Question 20

What are the potential complications of untreated acute cholecystitis?

Answer 20

Gallbladder gangrene, perforation, and peritonitis.

Question 21

What is the significance of a positive Murphy’s sign?

Answer 21

It suggests gallbladder inflammation, commonly seen in acute cholecystitis.

Question 22

What is the typical duration of pain in biliary colic?

Answer 22

Pain usually lasts less than 6 hours and resolves once the gallstone dislodges.

Question 23

What differentiates biliary colic from acute cholecystitis?

Answer 23

Biliary colic involves temporary pain without inflammation, while acute cholecystitis includes persistent pain with gallbladder inflammation.

Question 24

What is Reynold’s pentad?

Answer 24

Charcot’s triad plus hypotension and altered mental status, indicating severe acute cholangitis.

Question 25

What lifestyle modification can reduce the risk of biliary colic?

Answer 25

Adopting a low-fat diet to decrease gallbladder stimulation and stone formation.