Gallstones Flashcards
What are the different types of gallstone?
Cholesterol:
- Supersaturated bile, may be due to loss of bile salts.
Pigment:
- Occurs in haemolytic anaemia due to increased pigment (bilirubin from RBC breakdown)
Mixed:
- Alteration in bile composition leads to precipitation of cholesterol along with bile pigment
What is the clinical presentation of gallstone-related disease?
Either biliary colic or acute cholecystitis
Biliary colic:
- Severe, constant, crescendo pain
- Epigastic (may be RUQ, or radiate over right shoulder/subscapular)
- May be associated with over-indulgence with food
Acute cholecystitis:
- Severe localised RUQ pain
- Associated with tenderness and muscle-guarding/rigidity
What investigations can be carried out in gallstone-related disease?
FBC:
- Biliary colic = no real changes
- Acute cholecystitis = moderate leucocytosis and increased CRP/ESR
LFTS:
- Serum bilirubin, ALP and ALT/ASP may increase
Ultrasound to look for:
- Gallstones
- Thickening of gall bladder wall
- Diameter of common bile duct
What are the differential diagnoses of biliary colic?
- Renal colic
- Pancreatitis
- Atypical peptic ulcer disease
- IBS (spasm of hepatic flexure)
- Right colonic carcinoma
What are the differentials in acute cholecystitis?
- Acute pancreatitis
- Perforated peptic ulcer
- Hepatic abscess
What is the management of gallstone-related disease?
Medical:
- IV fluids
- Opiate analgesia
- IV antibiotics
- Nil by mouth
Surgical:
- Laproscopic cholecystecomy
What is Courvoisier’s law?
Courvoisier’s law states that, in the presence of jaundice, an enlarged gallbladder is unlikely to be due to gallstones; rather carcinoma of the pancreas or the lower biliary tree is more likely.
