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GI SOH > Gallstones > Flashcards

Gallstones Flashcards

1
Q

What are gallstones?

A

Hard stone like material formed within the biliary system, mainly in the GB
They make the bile sticky and thick

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2
Q

Why do gallstones occur?

A

Formed when there is an imbalance between the ratio of cholesterol to bile salts

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3
Q

Cholesterol stones

A

Excess cholesterol in bile, crystals of cholesterol

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4
Q

Pigment stones

A

Bilirubin excess

Crystals of bilirubin form

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5
Q

Aetiology (5 F’s)

A 
Female
Forty
Fertile
Fat
Fair
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6
Q

Complications

A 
Acute cholecystitis 
Chronic cholecystitis 
Empyema 
Carcinoma
Ascending cholangitis 
Obstructive jaundice 
Gallstone ileus 
Acute pancreatitis
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7
Q

Biliary colic - clinical presentation

A 
Gradual build up of RUQ pain 
Pain lasts for 2-6 hours 
Radiates to the back or right shoulder 
Loss of appetite - exacerbated by eating (?)
Nausea
Indigestion
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8
Q

Biliary colic - management

A

Pain killers
Low fat diet
Observations every 3-6 months

Symptoms gradually worsen:
Fit - cholecystectomy
Unfit - ursodeoxycholic acid

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9
Q

What is cholecystitis?

A

Inflammation of the gall bladder due to gallstones.
Gallstones obstructing the outflow of bile (cystic duct)
Acute or chronic

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10
Q

Acute cholecystitis - clinical presentation

A 
Sudden sharp RUQ pain 
Radiates to right shoulder 
Persistent pain 
Fever
Jaundice
N&V
Sweating
Loss of appetite
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11
Q

Acute cholecystitis - investigations

A 
Murphy's sign +ve (deep inspiration, sudden pain as GB hits hand) 
Blood tests 
US (first line imaging)
MRCP +/- ERCP
CT scan
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12
Q

Acute cholecystitis - management

A

Fasting
IV fluids
IV antibiotics

Cholecystectomy

  • either within a few days of presentation
  • OR elective surgery 3-6 months later
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13
Q

Chronic cholecystitis - what is it?

A

May develop after bouts of acute cholecystitis

GB wall is thickened due to fibrosis

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14
Q

Chronic cholecystitis - clinical presentation

A 
Severe RUQ pain 
Radiates to the back or right shoulder 
Fever
Jaundice
Itch
N&V
Pale stools
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15
Q

Chronic cholecystitis - investigations

A 
Murphy's sign +ve
Blood tests
US
CT
MRCP +/- ERCP
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16
Q

Chronic cholecystitis - management

A

Cholecystectomy

17
Q

Gallstones in CBD - clinical presentation

A

Jaundice
Itch
Nausea
Loss of appetite

18
Q

Gallstones in CBD - investigations

A

MRCP

Obstructive LFTs - Increased ALP, increased GGT

19
Q

Gallstones in CBD - management

A

Small stone - ERCP

Large stone - surgery

20
Q

Gallstones causing acute pancreatitis - management

A

Cholecystectomy

Frail - ERCP

21
Q

Gallstone ileus - what is it?

A

Fistula between the GB and duodenum

Gallstone passes through the SI causing a blockage

22
Q

Gallstone ileus - clinical presentation

A

Intermittent colic

Swollen abdomen

23
Q

Gallstone ileus - management

A

Urgent/elective cholecystectomy

GI SOH (71 decks)

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