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General Surgery - Phase II > Gallstones > Flashcards

Gallstones Flashcards

1
Q

What are the 3 different types of Gallstones?

A

Cholesterol stones - Large, often solitary
Pigmented stones - Small, gritty
Mixed stones - Multiple, cholesterol main component

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2
Q

What are the risk factors for Cholesterol gallstones?

A 
Obesity, high fat diet
Female
Increasing age
Pregnancy
OCP
Loss of terminal ileum (↓bile salts)
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3
Q

How do Cholesterol gallstones form?

A

Due to Admirand’s Trangle

  • ↓ bile salts
  • ↓ lecithin
  • ↑ cholesterol
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4
Q

What are Pigmented gallstones formed of?

A

Calcium bilirubinate

Associated with heamolysis

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5
Q

What are some of the causes of Gallstones forming?

A

Gall bladder hypomobility (Causes stasis) eg TPN, fasting, OCP, pregnancy
Biliary sepsis
Admirand’s triangle (↓bile salts, ↓lecithin, ↑cholesterol)

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6
Q

What are the complications of Gallstones?

A

Gallbladder - Biliary colic, Cholecystitis (Acute/Chronic), Mucocele, Carcinoma
CBD - Obstructive jaundice, Pancreatitis, Cholangitis
Gut - Gallstone ileus (Small bowel obstruction due to gallstones)

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7
Q

What causes Biliary colic?

A

Gallbladder spasms against stone impacted in neck (Hartmann’s pouch)
Can be in CBD, but less common

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8
Q

What are the differentials for Biliary colic?

A

Cholangitis
Cholecystitis
Pancreatitis
Bowel perforation

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9
Q

Define Acute Cholecystitis

A

Inflammation of Gallbladder usually due to a stone becoming stuck within Hartmann’s pouch (but can be due to surgery or sepsis) causes infection

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10
Q

How does Acute Cholecystitis present?

A

RUQ pain - Continuous + severe. Radiates to R scapula + epigastrium
Vomiting
Fever
Raised WCC

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11
Q

What is Murphy’s sign?

A

Place 2 fingers over the Gallbladderand ask pt. to breath in

Causes pain + pt attempts to catch breath

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12
Q

What are the complications of Acute Cholecystitis?

A

Gangrene
Perforation
Chronic Cholecystitis
Empyema

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13
Q

What investigations can be done for a patient with suspected Acute Cholecystitis?

A

Bloods -WCC, U+Es, LFTs, CRP, Clotting, G+S
Erect CXR - check for perforation
US - Thickened gallbladder, dilated ducts (>6mm), shadow from stones
Can do MRCP if unsure after US

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14
Q

What is the management of Acute Cholecystitis?

A

Conservative - NBM, Fluids, Analgesia, cefuroxime and metronidazole
Surgery - Elective 6-12 weeks after, if

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15
Q

What is the treatment if an empyema develops in Acute Cholecystitis?

A

Pt will have high fever + RUQ mass

Cholecystostomy (Percutaneous drainage of pus)

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16
Q

What are the symptoms of Chronic Cholecystitis?

A 
Dyspepsia
Vague upper abdominal discomfort
Distension
Bloating
Nausea
Burping
*Symptoms worsened by fatty foods due to cholecystokinin release from gallbladder*
17
Q

What investigations can be done in a patient with suspected Chronic Cholecystitis?

A

AXR - Show porcelain gallbladder
US - Fibrotic, shrunken gallbladder with stones
MRCP

18
Q

What is the management of Chronic Cholecystitis?

A

Medical - Bile salts (Not very effective)

Surgical - Elective cholecystectomy, ERCP if distended bile ducts/stones on US

19
Q

Define Cholangitis

A

Infection of the bile duct usually caused by bacteria ascending from the duodenum. It tends to happen when the bile duct is already partially blocked by gallstones

20
Q

How does Cholangitis present?

A

RUQ pain
Fever, raised WCC
Jaundice
(Charcot’s triad)

21
Q

What investigations can be done in a patient with suspected Cholangitis?

A

Bloods
US
MRCP

22
Q

What is the treatment for Cholangitis?

A

Fluids
Ciprofloxacin + Metronidazole
ERCP to unblock bile duct
Cholecystectomy once settled

23
Q

What are the indications for surgery in pts with Gallstones?

A 
Symptomatic
Blockage of bile ducts
Inflammation of Gallbladder
Large gallstones (>2cm)
Non functioning Gallbladder
24
Q

What is Primary sclerosing cholangitis?

A

Inflammatory fibrosis of the bile ducts, suspected to be autoimmune. Effects the Gallbladder and Liver.

25
Q

How does Primary sclerosing cholangitis present?

A 
Asymptomatic - LFTs derranged, hepatomegaly
Jaundice
Puritis
RUQ pain
Fatigue
Wt loss
Night sweats
Fever
26
Q

What investigations can be done in a patient with suspected Primary sclerosing cholangitis?

A

Bloods - LFTs, GGT, Increase in immunoglobulin
MRCP/ERCP
US

27
Q

What is the management of Primary sclerosing cholangitis?

A

Supportive
Stents/balloons to hold open any strictures which may be causing Cholangitis
Slowly progresses to liver cirrohsis/failure - need transpant

General Surgery - Phase II (9 decks)

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