Gallstones Flashcards
What are the constituents of bile?
92% water Bile salts/acids Bile pigment (bilirubin, biliverdin) Cholesterol Inorganic compounds
What are the different types of gallstones?
Mixed stones make up 75-90%
Cholesterol stones
Pigment stones (calcium bilirubinate)
Calcium carbonate stones
Describe the biliary tree.
Bile canalculi beside the hepatocytes join to form the left and right hepatic ducts which becomes the common hepatic duct. This joins the cystic duct to become the common bile duct which joins with the pancreatic duct forming the ampulla of vater.
What structure prevents duodenal reflux into the bilary tree?
Sphincter of Oddi
Describe the characteristics of Pigment Stones (4)
Numerous, jet black, 0.5-1cm, uniform size
What is the pathogenisis of Mixed Gallstones? (3)
Abnormalities of bile constituents
Bile Stasis
Infection
What are the fat-solvable vitamins?
Vitimins A,D,E and K
What hormone is released from endocrine cells in the duodenal mucosa to stimulate gallbladder contractions?
Cholecystokinin-pancreozymin
Where is Bile reabsorbed?
Terminal Ileus
The Coeliac Trunk divides into which arteries?
Left gastric
Splenic
Hepatic
What does the Porta Hepatis consist of?
Portal Vein
Extrahepatic Bile Ducts
Hepatic Arteries
What usually forms the core on which bile stones are built?
Bacteria
What is the result of unresolved obstruction of the cystic duct?
A mucocoele which is palpable and tender
This can become an empyema if infected
Gall bladders commonly show a Chronically Obstructed histological pattern. What are the features of this? (4)
Atrophied Mucosa
Submucosal and subserosal fibrosis
Hypertrophy of the muscular wall
Diverticula extending into the muscular layer (Rokitansky-Aschoff sinuses)
What is chronic inflammation of the Gallbladder called when there is no evidence of a stone on cholecystectomy?
Cholecystitis sans stones
What is the cause and definition of bilary colic?
Transient obstruction by a stone causing acute pain
What is the cause and definition of acute cholecystitis?
Prolonged obstruction by stone leading to chemically inflamed tissue.
How would a patient with acute cholecystitis differ from a patient with bilary colic clinically?
A patient with acute cholecystitis would appear systemically unwell with tachycardia and a fever.
What is the normal diameter of the bile ducts?
0.6cm
What are the aims of investigations into a patient with gallstone symptoms? (3)
To rule out haematological or hepatic causes
To establish if there is a stone and its location
To assess the bile ducts for suggestion of dilation or tumours
Name 3 common haemolytic disorders which may need rules out by blood tests in gall stones
Hereditary spherocytosis
Sickle cell anaemia
Thalassaemias
What investigation is most commonly carried out in a patient with suspected gallstones?
Ultrasonography
What two things are most commonly demonstrated pathologically with ultrasound?
Thickening of the gallbladder wall (due to inflammation or fibrosis)
Dilitation of the common duct system
Which are stones often not directly visualised by ultrasonography?
They are often obstructed by gas in the duodenum
What other investigations can be employed to assess gallstone disease?
ERCP
MRCP
Endoscopic sphincterotomy
What is the mnemonic for the ‘typical’ gallstone patient? (5)
Fair, fat, female, fertile and forty
What is raynauds pentad and what disease is it associated with?
Jaundice Fever RUQ pain Shock Confusion
Ascending cholangitis
