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Gastrointestinal > Gallstones > Flashcards

Gallstones Flashcards

1
Q

What is the prevalence of gallstones and related diseases.

A

They are present in 7% of men and 15% of women aged 18-65.
The overall prevalence is 11%.
They are rare before the 3rd decade.

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2
Q

What does bile consist of. (3)

A

Cholesterol.
Bile salts.
Lecithin.

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3
Q

What are the types of gallstone. (3)

A

Cholesterol.
Pigment.
Mixed.

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4
Q

What is biliary colic.

A

It is pain due to the temporary impaction of a stone in the gall bladder neck or cystic duct.
It is a severe, constant pain, that has a crescendo characteristic.

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5
Q

What are the symptoms of biliary colic. (3)

A

Usually pain begins in the epigastrium, but there may be RUQ pain.
The pain may radiate to the tip of the right scapula.
Vomiting/nausea.

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6
Q

What is the physical signs of biliary colic.

A

Tender RUQ.

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7
Q

What is cholecystitis.

A

An impacted stone obstructing the gall bladder outlet, which may result in infection of the accumulating bile.
In 95% of cases, a gallstone is found to be the cause.

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8
Q

What are the symptoms of acute cholecystitis. (6)

A 
Constant RUQ or epigastric pain.
There may be referred pain to the tip of the right scapula. 
Fever. 
Vomiting.
Local peritonism. 
Gallbladder mass.
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9
Q

What are the physical signs of cholecystitis. (4)

A

Pyrexia.
Tenderness.
Rebound and guarding in RUQ.
Murphy’s sign: patient catches their breath on inspiration when two fingers are placed in the RUQ. (only valid if same test is negative in LUQ)

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10
Q

What are the anatomical locations that can develop complications due to gallstones. (3)

A

Gall bladder.
Biliary tree.
Bowel.

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11
Q

What are the potential complications of gallstones in the gall bladder. (4)

A 
Biliary colic. 
Cholecystitis (acute and chronic)
Empyema. 
Mucocele. 
Carcinoma. 
Mirizzi's syndrome.
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12
Q

What are the potential complications of gallstones in the biliary tree. (3)

A

Obstructive jaundice.
Pancreatitis.
Cholangitis.

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13
Q

What is the potential complication of gallstones in the bowel.

A

Gallstone ileus.

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14
Q

What is gallstone obstructive jaundice.

A

Gallstone impacts in, and obstructs the common bile duct.

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15
Q

What are the symptoms of gallstone obstructive jaundice. (5)

A 
Jaundice. 
Pale stools. 
Dark urine. 
Pruritus.
Symptoms of biliary colic, or painless.
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16
Q

What are the signs of gallstone obstructive jaundice. (2)

A

Jaundice.

There may be tenderness in the RUQ.

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17
Q

What is ascending cholangitis.

A

Gallstone impacted in the common bile duct, resulting in infection of the biliary system.

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18
Q

What are the symptoms of ascending cholangitis. (6)

A

Pale stools.
Dark urine.
Pruritus.
Charcot’s triad: Jaundice, RUQ pain, fever.

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19
Q

What are the signs of ascending cholangitis. (3)

A

Pyrexia.
RUQ tenderness.
Rigors.

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20
Q

What is gallstone ileus.

A

Gallstone erodes through into the duodenum.

It may cause a mechanical bowel obstruction.

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21
Q

What is normally seen biochemically with cholestasis.

A

Elevated ALP.

If it is severe there will also be elevated bile acid levels and elevated bilirubin.

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22
Q

What is cholestasis due to.

A

It results from an abnormality of bile flow.

23
Q

What is meant by the term ‘biliary disease’

A

It relates to pathology at any level from the small intrahepatic bile ducts to the sphincter of oddi.

24
Q

Does biliary disease and cholestatic disease always occur together.

A

There is a very significant overlap between the two, but there are situations in which cholestasis can exist without biliary disease, and situations in which biliary disease can exist without cholestasis.

25
Q

Give examples of pathology when cholestatis disease occurs without biliary disease. (2)

A

Transporter disease.

Drug induced cholestasis.

26
Q

Give an example of pathology when biliary disease occurs without cholestasis.

A

When disease of the bile duct does not impact on bile flow.

27
Q

Are gallstones more common in men or women.

A

Under 40, there is a 3:1 female preponderance.

In the elderly, the sex ratio is about equal.

28
Q

Where are cholesterol gallstones more common.

A

In developed countries.

29
Q

Where are pigmented gallstones more common.

A

In developing countries.

30
Q

What do the majority of gallstones consist of.

A

They are of mixed composition. (cholesterol and pigment).

31
Q

What calcium salts do gallstones contain. (3)

A

Calcium bilirubinate.
Calcium carbonate.
Calcium palmitate.

32
Q

What are the mechanisms for cholesterol gallstone formation. (3)

A

Increased cholesterol secretion.
Impaired gallbladder emptying.
Decreased bile salt formation.

33
Q

What are the risk factors associated with increased cholesterol secretion. (5)

A 
Old age. 
Female gender. 
Pregnancy.
Obesity. 
Rapid weight loss.
34
Q

What are the risk factors associated with impaired gallbladder emptying. (5)

A 
Pregnancy. 
Gallbladder stasis. 
Fasting.
Total Parenteral Nutrition. 
Spinal Cord Injury.
35
Q

What is the risk factor for decreased bile salt secretion.

A

Pregnancy.

36
Q

What are the two main subsets of pigmented gallstones.

A

Black.

Brown.

37
Q

What are the risk factors for developing black gallstones. (4)

A

Haemolysis.
Age.
Hepatic Cirrhosis.
Ileal Resection/disease.

38
Q

What are the risk factors for developing brown gallstones. (2)

A

Infected Bile.

Stasis.

39
Q

What percentage of patients with gallstones will develop clinical symptoms.

A

10%.

40
Q

What are the two mainifestations of symptomatic gallstones.

A

Biliary colic.

Cholecystitis.

41
Q

Where do patients with gallstones typically experience pain. (2)

A

70% in the epigastrium.

20% in RUQ.

42
Q

Where does biliary colic pain usually radiate to.

A

It radiates to the interscapular region or to the tip of the right scapula.

43
Q

What is the differential diagnosis for biliary colic pain. (6)

A 
Biliary colic.
IBD. (spasm of the hepatic flexure.)
Carcinoma of the right side of the colon. 
Atypical peptic ulcer disease. 
Renal colic. 
Pancreatitis.
44
Q

How many cases of cancer in the gallbladder are associated with gallstones.

A

95% of cases are associated with gallstones.

45
Q

What is the differential diagnosis for cholecytitis pain. (6)

A 
Cholecystitis. 
Acute pancreatitis. 
Perforated peptic ulcer. 
Intrahepatic abscess. 
Basal pneumonia. 
MI.
46
Q

What are cholesterol stones like. (2)

A

Large.

Often solitary.

47
Q

What are pigmented stones like. (3)

A

Small.
Friable.
Irregular.

48
Q

What is Admirand’s triangle. (4)

A 
If you have:
Low lecithin. 
Low bile salts. 
High cholesterol. 
You have a higher risk of developing a cholesterol gallstone.
49
Q

What are risk factors for gallstones becoming symptomatic. (2)

A

Smoking,

Parity.

50
Q

What are the symptoms of chronic cholecystitis (6)

A

Chronic inflammation of the gallbladder - it may have colic.
‘Flatulent dyspepsia.’ = vague abdominal discomfort, abdominal distention, nausea, flatulence, and fat intolerance.

51
Q

What are the clinical features of common bile duct stones. (3)

A

Biliary colic, fever, jaundice (acute cholangitis). This triad is only present in the minority of patients.
Abdominal pain is the most common symptom (it has the typical features of biliary colic)
Jaundice is variable and is almost always preceeded by abdominal pain.
Fever is only present in the minority of patients.

52
Q

What does the presence of fever indicate in a patient presenting with common bile duct stones. (2)

A

It indicates biliary sepsis and sometimes an associated septicaemia.

53
Q

What are the physical signs of a patient with common bile duct stones. (4)

A

If a patient is examined between episodes, there may be no abnormal physical findings.
During a symptomatic episode, the patient may present with:
Jaundice.
Fever.
Tachycardia.
Tenderness in the RUQ, which varies from mild to extremely severe.

54
Q

What does widespread abdominal tenderness extending from the epigastrium to the LUQ, associated with distention, tachycardia, fever and jaundice indicate.

A

It may indicate stone-related pancreatitis.

Gastrointestinal (35 decks)

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