Gallstones Flashcards
What are gallstones
They are stones that obstruct the billary tree
Who gets gallstones
Fat, Fertile, Female, Fair, and Forty
Types of Gallstones
Cholestrol - 80% cases and large
Bile pigment - small and dark, made up of bilirubin and calcium salts. Black or Brown.
Risk factors of Gallstones
Increasing age
Female
Family history
Sudden weight loss
Diabetes
Oral contraception
Smoking
Symptoms of Gallstones
90% asymptomatic
How can gallstones present like
Billary/gallstone colic
Acute cholecystitis
Cholangitis
Symptoms of billary colic
Epigastric/ RUQ pain radiating to the intrascapular region (back)
Pallor
sweating
N/V
Maybe Jaundice - if stone passes to CBD
Not much
Symptoms of Acute Cholecystitis
Epigastric (70%)/RUQ (20%) pain radiating to the R shoulder/tip of scapula.
vomiting and fever are the main differentiate from billary colic
leukocytosis
If obstructive –> Jaundice
Investigations for gallstones
USS –> first line for gallstones
CT and Magnetic resonance cholangiopancreatography (MRCP) if dilated ducts seen on USS
Treatment for gallstones
If symptomatic should be treated with laparoscopic cholecystectomy.
Analgesia
ursodeoxycholic
Antibiotics
stone dissolution and shock wave lithotripsy
Where is the cystic duct
duct from gallbladder that joins the extrahepatic duct to for the common bile duct
Treatment of bilary colic
Analgesia to releive pain
NBM and try to rehydrate
Elective laparoscopic cholecystectomy
How would you investigate Billary colic
Aim is to exclude other causes
Urinalysis
CXR
ECG
Obstructive Juandice with common bile duct stones
Pale stools
Dark urine
Yellowing of skin
Itching
Symptoms of cholingitis
RUQ pain
Juandice
Rigors
What is Charcot’s Triad
RUQ pain
Jaundice
Rigors
Medicine treatment of cholingitis
IV ABx according to trust guidelines
What is acute cholecystitis
It is the inflammation/infection of the gallbladder wall
It is almost always associated with obstruction of the gallbladder neck or cystic duct by gallstones
What you will see on US for cholecystitis
Thickening of the gallbladder wall
Signs of acute cholecystitis
Murphy’s sing
right hypochondrial tenderness
sometimes gallbladder mass (30%)
10% jaundice but this means stone moved to CBD which is a complication
How to investigate acute cholecystitis
FBC - raised WCC
USS - thickened gallbladder wall
amylase - to exclude pancreatitis
AXR - may show radio-opaque stones
Medical treatment of acute cholecystitis
Bed rest
Analgesia
Abx
fluid balance
What is chronic cholecystits
mostly associated with gallstones
recurrent attacks of upper abdominal pain occuring at night and following a heavy meal
follows presentation of acute, but ironically Sx are milder.
Pts are advised for elective cholecystectomy
What is the difference between acute cholecystits and billary colic
with acute cholecystitis there is peritonism (fever, WCC)
while billary colic shouldnt have these
What is ascending cholingits
it is infection of the bile duct
what can precipitate attacks of gallstones
fatty foods and usually lasts <6h
bile is excreted thus stone moving around in gallbladder thussss restricting neck therefore pain
