Gallstones Flashcards
Gallstones can happen to anyone but what are the 5 Fs to help remember in which people they are most common
- Fat
- fair
- fertile
- forty
- female
Which are the most common gallstones
Cholesterol stones (75%)
Which are the non cholesterol stones
- categorized as either black or brown pigment stones
- Black: bilirubin and large amounts of mucin glycoproteins
- brown: related to worm infestation
What is lithogenic bile
Bile which contains high concentrations of cholesterol and lower concentrations of phospholipids and bile salts
What percentage of asymptomatic gallstones become symptomatic?
2% of patients with asymptomatic gallstones will develop symptoms per year
How do symptomatic gallstones present
Patient typically present with biliary colic which consists of colicky pain in the right upper quadrant radiating to the tip of the scapula.
Patient may complain of associated symptoms such as nausea and vomiting
Where does the stone impact to result in symptomatic gallstones
- impacts in the cystic duct or Hartmans pouch
Investigation of choice for suspected gallstone disease
Abdominal ultrasound scanning
Treatment of choice for symptomatic patients with gallstone related problems, what are the goals of the procedure
Cholecystectomy. The objectives are to eliminate the gallbladder, to exclude stones in the biliary tree and to ensure that the bile ducts are not damaged
Options for medical treatment of gallstones
- Medical dissolution therapy: Chenodeoxycholic acid or ursodeoxycholic acid
- Contact dissolution therapy: irrigation with methyl terbutyl ether which rapidly dissolves gallstones
- Extracorporeal shockwave lithotripsy
Indications and contra indications for medical dissolution therapy
- indicated: Cholesterol stones Which are non-calcified and in the presence of a functioning gallbladder. Also only applicable to small gallstones
- contraindications: severe symptoms, pregnancy, liver disease, severe atherosclerosis
What is acute cholecystitis
In acute cholecystitis, a gallstone becomes impacted in the cystic duct or Hartmanns pouch and there is inflammation and infection of gallbladder wall
Symptoms of acute cholecystitis
Severe colicky abdominal pain in the right upper quadrant which radiates round the tip of the scapula. There is associated nausea and vomiting
Clinical exam findings in acute cholecystitis
- patient is pyrexial, tenderness and guarding in right upper quadrant and murphys sign is positive
Natural history of acute cholecystitis
- Majority of cases, stone will disimpact and the inflammatory process will resolve with resultant fibrosis
- Formation of abscess: high spiking fevers, rigors and leucocytosis of >15 000
- Perforation of the gallbladder: localized, free or into adjacent viscus
