Gallstones Flashcards
Function of gallbladder
Bile reservoir
Concentrates bile
Secretes bile after meal (CKK)
Composition
Mixed
Cholesterol
Pigment
Risk factors for gallstones
4F’s
- female
- forty
- fat
- fertile
High Cholesterol
Pigment (haemolytic anaemia, bile infection)
Presentation of gallstones
Dyspepsia
Biliary colic (pain when stone blocks BD)
Jaundice
Gallstone Ileus (stone entered duodenum get stuck in ileum)
Empyema
Perforation
What is choledocholithiasis
The presence of gallstones in the common bile duct
What can choledolithiasis cause
Obstructive Jaundice
Acute pancreatitis
Ascending cholangitis
Symptoms of obstructive jaundice
Pain Yellowing Dark urine Pale stool Pruritis Steatorrhoea
How does choledolithiasis cause pancreatitis
Blockage of the common bile duct can disrupt the digestive enzymes produced by the pancreas
If the opening is blocked it can cause the enzymes to digest the pancreas instead of food
What is ascending cholangitis and how is it caused
Infection of the bile duct proximal to the obstruction
Usually caused by bacteria ascending from its junction with duodenum
Tends to occur if the bile duct is already partially obstructed by gallstones
Presentation of ascending cholangitis
Charcot’s Triad
- abdominal pain
- jaundice
- fever with rigors
Blood tests
LFT’s (AST, ALT, ALP)
Amylase, lipase
WCC
Main Investigations
USS - may show dilation of bile duct and identify stones
distinguishes between cholangitis and cholecystitis
Other imaging
MRCP
ERCP
EUS - if tumour, biopsy
CT - obstructive jaundice
Non-Operative Treatment
Dissolution - oral bile acid
Operative Treatment
Cholecystectomy (laparoscopic, open, mini, single port, NOTES,
