Gallstones

Question 1

What are gallstones

Answer 1

They are stones that obstruct the billary tree

Question 2

Who gets gallstones

Answer 2

Fat, Fertile, Female, Fair, and Forty

Question 3

Types of Gallstones

Answer 3

Cholestrol - 80% cases and large

Bile pigment - small and dark, made up of bilirubin and calcium salts. Black or Brown.

Question 4

Risk factors of Gallstones

Answer 4

Increasing age

Female

Family history

Sudden weight loss

Diabetes

Oral contraception

Smoking

Question 5

Symptoms of Gallstones

Answer 5

90% asymptomatic

Question 6

How can gallstones present like

Answer 6

Billary/gallstone colic

Acute cholecystitis

Cholangitis

Question 7

Symptoms of billary colic

Answer 7

Epigastric/ RUQ pain radiating to the intrascapular region (back)
Pallor

sweating

N/V

Maybe Jaundice - if stone passes to CBD

Not much

Question 8

Symptoms of Acute Cholecystitis

Answer 8

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

Question 9

Investigations for gallstones

Answer 9

USS –> first line for gallstones

CT and Magnetic resonance cholangiopancreatography (MRCP) if dilated ducts seen on USS

Question 10

Treatment for gallstones

Answer 10

If symptomatic should be treated with laparoscopic cholecystectomy.

Analgesia

ursodeoxycholic

Antibiotics

stone dissolution and shock wave lithotripsy

Question 11

Where is the cystic duct

Answer 11

duct from gallbladder that joins the extrahepatic duct to for the common bile duct

Question 12

Treatment of bilary colic

Answer 12

Analgesia to releive pain

NBM and try to rehydrate

Elective laparoscopic cholecystectomy

Question 13

How would you investigate Billary colic

Answer 13

Aim is to exclude other causes

Urinalysis
CXR
ECG

Question 14

Obstructive Juandice with common bile duct stones

Answer 14

Pale stools

Dark urine

Yellowing of skin

Itching

Question 15

Symptoms of cholingitis

Answer 15

RUQ pain

Juandice

Rigors

Question 16

What is Charcot’s Triad

Answer 16

RUQ pain

Jaundice

Rigors

Question 17

Medicine treatment of cholingitis

Answer 17

IV ABx according to trust guidelines

Question 18

What is acute cholecystitis

Answer 18

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

Question 19

What you will see on US for cholecystitis

Answer 19

Thickening of the gallbladder wall

Question 20

Signs of acute cholecystitis

Answer 20

Murphy’s sing

right hypochondrial tenderness

sometimes gallbladder mass (30%)

10% jaundice but this means stone moved to CBD which is a complication

Question 21

How to investigate acute cholecystitis

Answer 21

FBC - raised WCC

USS - thickened gallbladder wall

amylase - to exclude pancreatitis

AXR - may show radio-opaque stones

Question 22

Medical treatment of acute cholecystitis

Answer 22

Bed rest

Analgesia

Abx

fluid balance

Question 23

What is chronic cholecystits

Answer 23

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

Question 24

What is the difference between acute cholecystits and billary colic

Answer 24

with acute cholecystitis there is peritonism (fever, WCC)

while billary colic shouldnt have these

Question 25

What is ascending cholingits

Answer 25

it is infection of the bile duct

Question 26

what can precipitate attacks of gallstones

Answer 26

fatty foods and usually lasts <6h

bile is excreted thus stone moving around in gallbladder thussss restricting neck therefore pain