Gallstones Flashcards
Name the three constituents of bile?
Cholestrol
Bile pigments (breakdown products of Hb)
Phospholipids
Name the three major types of gallstones?
Pigment stones
What the the major risk factors for developing gallstones?
Fat Female Forty Fertile Fair Fhx OCP
What is acute cholecystitis?
Inflammed gallbladder following impaction within the neck of the GB
Describe the clinical presentation of acute cholecystitis?
Acute RUQ pain - can be reffered to (R) shoulder Vomiting FEVER* Increased WCC* PERITONISM
What is the main difference between bilary colic and acute cholecystitis?
Presence of inflammation
PYREXIA
Increased WCC
What is cholangitis?
Stone moves into the common bile duct = bile duct infection
Causes obstructive jaundice
RUQ pain
Fever (Charcot’s triad)
O/E what sign might be able to elicit acute cholecystitis?
Murphy’s sign - ask pt to breath in = pain and arrest of inspiration as inflamed GB catches the impinged fingers
Only (+ve) if (L) side NOT effected
What is a phlegnion?
A RUQ mass of omentum and bowel adherent which is inflamed and may be palpable
What might an ultrasound of the gallbladder show with suspected gallstones?
Thickened wall
Dilated common bile ducts (>6mm)
What might LFTs show with a patient with suspected gallstones?
Increased serum bilirubin - (cholangitis)
Increased ALP
Increased GGT
Describe bilary colic?
Gallstones are symptomatic with cystic duct obstruction or if passed into the common bile duct
RUQ pain - radiates to back
What is the most common presenting symptom with primary biliary cirrhosis?
Fatigue
Which three investigations are increased in primary biliary cirrhosis?
Increased AMA
Increased ALP
Increased IgM
Which two investigations are increased in primary sclerosing cholangitis?
Increased ANCA
Increased ALP
