Gallstones

Question 1

why do they arise

Answer 1

abnormal composition of bile and usually excess cholesterol

this causes hardening of bile and thus stones

Question 2

what causes it (5 Fs)

Answer 2

female 
foetus 
forty 
fair 
fat 
also drugs, cirrhosis and diabetes

Question 3

what are symptoms

Answer 3

asymptomatic
biliary colic
acute cholecystitis

Question 4

what is biliary colic

Answer 4

RUQ pain (? radiation to shoulder) due to stone in cystic duct 
causes tender RUQ, nausea and vomiting

Question 5

what is acute cholecystitis

Answer 5

infection of gallbladder due to accumulation of bile due to stone obstructing duct
causes constant RUQ pain (?shoulder), fever, vomiting, pyrexia, guarding, murphys sign

Question 6

how is it diagnosed

Answer 6

FBC, U&Es
US 1st line
LFTs - increased bilirubin and ALP
MRCP/ERCP

Question 7

how is it treated

Answer 7

IV antibiotics and fluid

laparoscopic cholecystectomy

Question 8

which antibiotics

Answer 8

IV amoxicillin, metrondiazole and gentamicin

Question 9

then step down to

Answer 9

PO co-trimoxazole and metrondiazole

Question 10

if allergic

Answer 10

IV vancomycin and metrondiazole and gentamicin

Question 11

what are complications

Answer 11

empyema
mucoele (mucus containing cyst of minor salivary gland)
obstructive jaundice
pancreatitis
cholangitis (infection of bile duct)
gallstone ileus (small bowel obstruction by stone)