Gallstones Flashcards
Define
Cholelithiasis is when there are stones in the gall bladder which causes severe pain in RUQ also known as biliary colic
Why do you get a colicky biliary pain in gall stones?
Because the stones obstruct the gall bladder and the bile duct and the contraction of the bile duct walls compress the gall stones up against the biliary duct wall and cause pain
How common are gallstones in the UK?
a) 1 in 10
b) 1 in 50
c) 1 in 500
d) 1 in 1000
a) 1 in 10
What are the 6 F’s of who gets gallstones?
fat, forty, female, fair, fertile, FHx
what substance makes up 80% of all gallstones?
cholesterol
Which stones are visible on x ray and which ones aren;t?
cholesterol stones= not visible on x ray
Bilirubin stones= visible on x ray
What do brown stones mean?
Bacterial Infection
Because the bacteria hydrolyse conjugated bilirubin to unconjugated bilirubin and hydrolyse phospholipids leading to brown stones
Presenting symptoms of gall bladder causing biliary colic?
BILIARY COLIC» worse w/ fatty meal
Fever + RUQ pain which radiates to back
May get CHARCOT’S TRIAD due to the gallstones leading to acute cholecystitis
Palpable mass in RUQ
If gall stone pt has jaundice» what doe we know about where the stones have moved into?
Stones have moved into common bile duct
How long does the RUQ pain radiating to the right shoulder last for?
for 1-4 hours
Signs? (4)
Murphy’s
Guarding
RUQ tenderness
Maybe RUQ mass
Ix? (3)
USS of biliary tree= gold standard
ERCP/MRCP to explore more
LFTs» elevated ALP and GGT
Mx?
Mild» conservative= just reduce fat in diet
Surgical» laparoscopic cholecystectomy
Complications? what does it depend on? (3 groups)
Depends on where the gallstones have spread to:
Gall bladder stones= Acute cholecystitis
Common bile duct stones= Acute cholangitis, obstructive jaundice, pancreatitis
Gut stones= gallstone ileus
