Gallstones

Question 1

What are gallstones

Answer 1

Hard deposits in gallbadder - may consist of cholesterol, salt, bilirubin

Question 2

How common is it

Answer 2

8% of >40yrs have experienced

1 in 10 adults

Question 3

What are the causes

Answer 3

• unknown
• bile contains ++ cholesterol or bilirubin
• gallbladder doesn’t empyt properly

Question 4

What are the gallstones made out of

Answer 4

• CHOLESTEROL - most common –> large, solitary stones (radiolucent)
• BILE PIGMENTS - caused by haemolysis (broken down Hb) –> small, irregular, friable
• MIXED - cholesterol, pigment + calcium –> 10% are radiopaque

Question 5

What are the risk factors

Answer 5

• 4 Fs –> Fat, forty, female, fair (+pregnant)
• Fhx
• Diabetes
• High fat/cholesterol diet, low fibre

Question 6

what are the symptoms

Answer 6

• 90% asymptomatic –> until cause blockage
• -> may cause acute/chronic cholecystitis, pancreatitis, obstructive jaundice
• BILIARY COLIC most common presentation (caused by gallstone hitting cystic duct)
• ACUTE CHOLECYSTITIS - 2nd most common - distention of gallbladder w. subsequent necrosis + ischaemia

Question 7

What are some of the differential diagnoses

Answer 7

• Peptic ulcer
• IBS
• Reflux
• Pancreatitis
• tumour (stomach, pancreas, colon, gallbladder)

Question 8

What investigations would you perform

Answer 8

• USS - demonstrate stones

- Urinalysis, CXR + ECG - exclude other disease

Question 9

What are some complications that can arise from gallstones

Answer 9

• biliary colic (radiates to back +/- jaundice)
• Acute/chronic cholecystitis (stone in neck of GB)
• Pancreatitis
• Obstructive jaundice (common bile duct obstruction)
• Cholangitis (infection of bile duct)
• Gallstone ileus (stone perforates through gallbladder into duodenum –> obstruction of terminal ileum)

Question 10

What is the treatment for gallstones

Answer 10

• Biliary colic = morphine, antiemetic
• Acute/chronic cholecystitis - pain relief, IV cefuroxime
• Cholangitis - IV cefuroxime + metronidazole

Question 11

What are the signs of cholecystitis

Answer 11

• RUQ/ epigastric pain
• Vomiting, fever
• Local peritonism
• Murphy’s sign
  (Ask pt to inhale whilst fingers hooked under liver border –> causes gallbladder to hit against fingers = pain)

Question 12

What are the signs for cholangitis

Answer 12

• CHARCOT’S TRIAD - jaundice, RUQ pain, rigors

- REYNOLD’S PENTAD of jaundice, RUQ pain, rigors, shock + confusion