Gallstones Flashcards
What are gallstones?
Most common disorder of the biliary tree and it is unusual for the gallbladder to be diseased in the absence of gallstones. Either cholesterol stones, pigment stones or a mixture
What causes cholesterol bile stones to form?
It happens when the liver produces bile that contains an excess of cholesterol, because there is either a relative deficiency of bile salts or a relative excess of cholesterol (‘lithogenic’ bile).
What is the cause of pigment stones?
It is almost always a consequence of bacterial or parasitic biliary infection. Infection allows bacterial β-glucuronidase to hydrolyse conjugated bilirubin to its free form, which then precipitates as calcium bilirubinate.
How do stones within gallbladder manifest?
Biliary colic or cholecystitis
What’s the clinical presentation of gallstones?
Typically, the pain occurs suddenly and persists for about 2 hours; if it continues for more than 6 hours, a complication such as cholecystitis or pancreatitis may be present
Pain is usually felt in the epigastrium (70% of patients) or right upper quadrant (20%), and radiates to the interscapular region or the tip of the right scapula
Dyspepsia, fatty food intolerance + flatulence
What is gallstone ileus?
Fistulae develop between the gallbladder and the duodenum, colon or stomach. Stone migrates to gut and causes obstruction.
How to gallstones cause jaundice?
Stone passing from the cystic duct into the common bile duct (choledocholithiasis), which may also result in cholangitis or acute pancreatitis.
How do you investigate?
1st line - Transabdo USS
CT & MRCP - detecting complications
What is management?
Symptomatic - laparoscopic cholecystectomy
What is management for bile duct stones?
Lithotripsy, endoscopic sphincterectomy, surgical bile duct exploration
What is acute cholecystitis
Inflammation due to obstruction of the gallbladder neck or cystic duct by a gallstone.
What are the clinical features of acute cholecystitis
RUQ/epigastric pain, radiates to shoulder tip
fever, pain, leucocytosis
O/E - right hyperchondrial tenderness, murphy’s sign, fever
What are investigations of acute cholecystitis?
FBC, CRP, LFTs
Erect CXR - exclude pneumonia and perforated viscus
USS
What is management of acute cholecystitis?
Rest
Pain reflief - NSAIDs or Opiates
Antibiotics IV - cephalosporin (cefuroxime) or PipTaz. Metronidazole in severely ill patients
IV fluids
Cholecystectomy
What is acute cholangitis?
Bacterial infection of bile ducts and occurs in patients with other biliary problems, such as choledocholithiasis, biliary strictures or tumours, or after ERCP.
