Gallstones Flashcards
what does bile contain
cholesterol, bile pigments, phospholipids
what are pigment and cholesterol stones
depending on concentrations. pigment stones (
what are some risk factors for stones becoming symptomatic
smoking, parity
prevalence of gallstones
8% of those >40y. 90% remain asymptomatic
what is acute cholecystitis
inflammation of the gallbladder
what is acute cholecystitis due to
stone or sludge impaction in neck of gallbladder.
symptoms acute cholecystitis
continuous epigastric or RUQ pain, vomiting, fever, local peritonism, GB mass
what is the main difference between acute cholecystitis and biliary colic
inflammatory component- local peritonism, fever, incr WCC
what happens if the stone moves to common bile duct
obstructive jaundice and cholangitis (infection of bile duct)
what is Murphys sign
lay 2 fingers over RUQ and as inspiration occurs there is pain and arrest of inspiration. only positive if it fails to happen on LUQ
what is a phelgmon
RUQ mass of inflamed adherent omentum and bowel may be palpable
tests in acute cholecystitis
incr WCC, US- thick walled, shrunken GB, pericholecystic fluid, stones, CBD
treatment acute chole
NBM, analgesia, IVI and cefuroxime. lap chole (remove GB)
when would you do an open cholecystectomy
if GB perforation
what could you perform in elderly for acute chole or if unsuitable for cholecystectomy
cholesytotomy- create stoma in gallbladder and insert a tube for drainage
what are the symptoms of chronic cholecystitis
chronic inflammation +- colic. flatulent dyspepsia- vague abdo discomfort, distension, nausea, flatulence, fat intolerance- fat stimulated cholecystokinin release and GB contraction.
treatment chronic chole
cholecystecomty
what is biliary colic
when gallstones are symptomatic. cystic duct obstruction or if passed into the CBD.
symptoms biliary colic
RUQ pain radiates to the back+- jaundice.
treatment biliary colic
analgesia, rehydrate, NMB, elective lap chole
complications gallstones in gallbladder and cystic duct
biliary colic, empyema, mucocoele, acute or chronic cholecystitis, carcinoma, Mirizzis syndrome
complications gallstones in bile ducts
obstructive jaundice, cholangitis, pancreatitis
complications gallstones in the gut
gallstone ileus
what is Charcots triad
RUQ pain, jaundice, rigors
