gallstones Flashcards
biliary colic pain
intermittent pain epigastric pain/ruq pain can radiate to scapular)? gallbladder stones after eating fatty food
cholecystitis presentation
constant pain inflammation peritoneum not jaundiced RUQ pain gallstones in gallbladder PLUS inflammation
cholangitis acute presentation
charcot triad fever RUQ pain jaundiced -dark urine -pale stools -obstructed cholestatic jaundice
visceral versus somatic pain
visceral
- autonomic= related to arterial blood supply
- intermittent pain
somatic
- constant pain
- t4 to t1
- localised to anatomy
- inflammation of the peritoneum
where does liver and spleen and gallbladder and diaphragm refer pain too
liver=right
spleen=left
gallbladder=right scapula
diaphragm=shoulder
presentation of gallstones
asymptomatic biliary colic cholecystitis empyema- pleuritis mucocoele: distended gb obstructive jaundice acute cholangitis acute pancreatitis gallstone ileus gallbladder cancer pain assoc. to fatty meal
risk factor for gallstones 5F
fat or rapid weight loss female fertile fair (Caucasian) forty >
how much bile is made a day
0.2-0.6 grams a day
how much bile is resorbed a day
12-32 grams
how large is the bile salt pool and how often does it cycle
2-4 grams
6-12 cycles a day
faecal loss of bile a day
0.2-0.6
3 main constituents of gallstones
cholesterol
calcium salts
bile pigments
what has to be imbalanced to make gallstones
bile salts
cholesterol
phospholipids
3 types of gallstones and % prevalence and causes
cholesterol 20% -5f's -contraceptive pill, low fibre -terminal ileal disease pigmented stone 5% -haemolytic anaemia mixed 75% -calcium bilirubinate and cholesterol
management of biliary colic
imaging for gallstones
laprascopic cholecystectomy
acalculous cholecytitis meaning
patient with intercurrent illness ie inflammation of the gallbladder but no gallstones
ERCP risks
bleeding
duodenal perforation
cholangitis
pancreatitis
word for gallstones in the gallbladder
cholecystolithiasis
word for gallstones in the cbd
choledocholithiasis
biliary disease dx diff
peptic ulcer disease GORD acute pancreatitis acute appenditicitis renal pathology IBS
biliary colic DX
blood tests -WCC normal -LFT normal -amylase normal USS
management principle for biliary colic
TREAT ONLY IF SYMPTOMATIC -conservative: low fat diet -medical: ursodeoxycholic acid -surgical: lithotripsy cholecystectomy
advantages and disadvantage of laparascopic cholecystectomy
-increased risk bile duct injury \+ - decrease pain -earlier discharge -function -improved cosmesis
presentation of acute cholecystitis
epigastric/ RUQ pain biliary colic more constant pain also radiation to shoulder tip/right scapula anorexia/nausea/vomit fever
