Gallstones

Question 1

What causes Gallstones?

Answer 1

80% caused by cholesterol crystalisation

Question 2

What causes the crystalisation? (3)

Answer 2

1. Cholesterol Supersaturation
2. Crystalisation promoting factors in bile
3. Reduced motility of Gallbladdder

Question 3

Why is there too much cholesterol? (3)

Answer 3

Diet, increased activity of HMG-CoA Reducatase, elevated leptin levels

Question 4

Other types of Stones (1)

Answer 4

Bile Pigment stones: Black (calcium bilirubinate), Brown (Calcium salts of fatty acids)

Question 5

Are they common?

Answer 5

Yes, 25-30% prevalence

Question 6

Who do they affect?

Answer 6

More women, uncommon before the age of 30

Question 7

Risk Factors (8)

Answer 7

Age, Obesity, Ileal disease, Female, Diabetes, Rapid weight loss, Family history, diet

Question 8

Symptoms (3)

Answer 8

Colicky pain in upper right quadrant, pain worse on consumption of fatty foods, morning pain

Question 9

Signs (4)

Answer 9

Fever, rigors (suggests cholecystitis), Guarding, Murphy’s Sign

Question 10

What bloods would you do?

Answer 10

Serum Bilirubin, Alkaline Phosphatase, Aminotransferase, CRP, U&E

Question 11

Other Investigations (2)

Answer 11

Abdominal Ultrasound, Biliary Scintigrophy

Question 12

Differentials (4)

Answer 12

IBS, Carcinoma of ascending colon, MI, Basal Pneumonia

Question 13

Treatment (4)

Answer 13

Analgesia (not morphine as causes sphincter of oddi contraction)
Cholecystectomy
Chenodeoxycholic Acid to dissolve stones
Statins to prevent cholesterol synthesis
Lithotripsy

Question 14

Complications (1)

Answer 14

Post Cholecystectomy Syndrome associated with Colonic Spasm