Gallstones Flashcards
List risk factors for gallstones
Age >40 Female Pregnancy OCP/ estrogen therapy obesity rapid weight loss Crohns disease Hemolysis
Hemolysis causes _______ gallstones
pigmented
Jaundice due to hemolytic anemia causes what changes in bilirubin levels?
Greater increase in unconjugated than conjugated bilirubin
Jaundice due to hepatitis causes what changes in bilirubin levels?
Similar increase in both conjugated and unconjugated bilirubin
Jaundice due to biliary duct stone causes what changes in bilirubin levels?
Greater increase in conjugated than unconjugated bilirubin
Bile is composed of:
Water, Bile acids, Phospholipids, Electrolytes, Cholesterol, Bilirubin
List three key features of biliary stone formation
supersaturation
crystal nucleation
stasis/ hypomotility
= cholelithiasis
List 6 conditions/ clinical manifestations of biliary stone formation
1) Symptomatic cholelithiasis
2) Acute cholecystitis
3) Chronic cholecystitis
4) Choledocholithiasis
5) Gallstone pancreatitis
6) Cholangitis
What is the treatment for symptomatic cholelithiasis?
cholecystectomy
How is acute cholecystitis diagnosed on MRI?
thickened gall bladder wall, pericholecystic fluid
What is the treatment for acute cholecystitis?
cholecystectomy
What are possible outcomes if cholecystectomy is not performed on a patient with acute cholecystitis?
perforation
gangrene
Describe the presentation of chronic cholecystitis
post-prandial RUQ pain, nausea
normal LFTs/CBD
fibrotic/ thickened gallbladder wall due to chronic irritiation
invariably associated with cholelthiasis
How is chronic cholecystitis treated
cholecystectomy
It is important to recognize porcelain gallbaldder because of the significant risk of _______
gallbladder cancer
tx= cholecystectomy
What is choledocholithiasis?
gallstones in duct, can occur even after cholecystectomy
What is the treatment for choledocholithiasis?
ERCP with stone extraction, sphincterotomy
What are possible complications of choledocholithiasis?
acute cholangitis
gallstone pancreatitis
Describe the presentation of gallstone pancreatitis
severe constant epigastric pain radiating to back
elevated WBCs, elevated bilirubin/ ALKP/ ALT/AST/ amylase/ lipase
CT with peri-pancreatic inflammation, dilated bile ducts, cholelithiasis
What is the treatment for gallstone pancreatitis?
IV fluids and medically stabilize
ERCP stone extraction
List key symptoms that suggest acute cholangitis
RUQ pain, fever, jaundice, hypotension, mental status changes
Describe the findings seen in acute cholangitis
Elevated WBCs, LFTs
MRCP shows common bile duct full of stones, obstruction of biliary tree, and purulent fluid filling biliary tree
List bacteria commonly implicated in acute cholangitis
E coli, Klebsiella, Enterobacter species
How is acute cholangitis managed?
Medical support including IV antibiotics, biliary drainage (via ERCP or PTC)
