gallstones Flashcards
what is the most common type of gall stones ?
cholesterol gallstone
what are the important associations with cholesterol gallstones ?
happens in older patients
elderly patients with gallstone symptoms can be an indication of cancer
what are the risk factors associated with cholesterol gallstone formation ?
excess estrogen - increased cholesterol (hence why women are at a higher risk, pregnancy too)
altered lipid metabolism
loss of bile salts
what are the risk factors associated with loss of bile salts ?
underproduction from the liver
poor reabsorption in the terminal ileum
where are bile salts reabsorbed ?
terminal ileum
what are the diseases associated with a loss of bile salts ?
cirrhosis
crohns disease
cystic fibrosis
clofibrate (inhibit bile acid synthesis)
bile acid resins
what are the other name for pigment stones ?
bilirubin stones
what type of patients are at a higher risk of developing pigment gall stones ?
any patient that has an excess formation of unconjugated bilirubin
extravascular hemolysis
cirrhosis
recurrent biliary tree infections
what are the symptoms of gall stone disease ?
usually asymptomatic
when it does - causes biliary colic
episodic RUQ pain that radiates to the right shoulder
often after eating fatty meals
what is the medical therapy used for galls tone disease ?
UDA - this works by reducing the cholesterol secretions in the bile
what is acute cholecystitis ?
inflammation of the gall bladder due to obstruction of the cystic duct
what are the clinical features of acute cholecystitis ?
RUQ pain with a fever no jaundice
radiates to the right scapula
associated with murphy’s sign
what is choledocolithiasis ?
common bile duct stone
biliary obstruction
what are the lab findings associated with choledocolithiasis ?
increase in alk phophate more than AST and ALT
increase in GGT
increase in direct bilirubin
what is a complication to choledocolithiasis ?
cholangitis
what are the x ray findings in chronic cholecystitis ?
porcelain gallbladder in X ray
what is the risk associated with chronic chlecystitis ?
gall bladder cancer
what are the causes of acalculous cholecystisis ?
not due to galls tones
usually associated with patients in the ICU , associated with stasis and ischemia
what are the gall bladder complications associated with AIDS ?
rare complication of end stage HIV
AIDs cholangiopathy
infection driven disease
biliary obstruction due to strictures
what is the most common causative organism of AIDS ?
cryptosporidium
followed by CMV
what is ascending cholangitis ?
stone blocks flow of bile
GI bacteria ascend
classic presenttion of ascending cholangitis ?
charcots triad :
fever abdominal pain and jaundice
law fe hypotension and confusion - reynolds pentad
what is the most common organism associated with ascending cholangitis ?
gram negatives - e coli , klebsiella enterobacter
which helminth is associated with ascending cholangitis ?
clonorchis siensis
helminth found in infected fish
what lab findings is associated with clonorchis sinensis ?
peripheral eosinophilia
what is the treatment for ascending cholangitis ?
antibiotics - covering gram negatives
biliary drainage - endoscopic sphincterectomy
what is a gallstone ileus ?
mechanical bowel obstruction caused by a gallstone - causing a fistula with the small intestines
what are the key imaging findings associated with gallstone ileus ?
air in the biliary tree
what is the result of gallstone pancreatitis ?
acute pancreatitis
what type of carcinoma is a gallbladder carcinoma ?
adenocarcinoma from chronic inflammation
what infection may be associated with gallbladder cancer ?
chronic salmonella infection
what is the cause of right shoulder pain ?
phrenic nerve irritation
what does failure to visualize the gallbladder on HIDA scan indicate ?
obstruction of the gall bladder
what is the presentation of biliary colic ?
neurohormonal stimulation by CCK
associated with nausea and vomiting
intermittent RUQ pain
what is the most common place to see a cholangicarcinoma ?
in the convergence of the right and left hepatic ducts
