Gallstones

Question 1

Define

Answer 1

Stones in the gall bladder

Question 2

Aetiology/risk factors:

Answer 2

3 types:

• Mixed (80%) due to an imbalance of bile salts, gastric motility, phospholipids, bilirubin and cholesterol
• Pure cholesterol (10%)
• Pigment stones (10%) - bilirubin due to haemolytic disorders

6F’s - family history, female, fat, forty, fertile and haemolytic disorders

Question 3

Investigations:

Answer 3

US of biliary tree is the gold standard

AXR some of the gall stones are radio-opaque

ERCP - removal and looking.

Question 4

Management:

Answer 4

Lifestyle

ERCP if severe

Question 5

Complications:

Answer 5

Inside the gall bladder:

• Biliary colic
• Cholecystitis
• gall bladder empyema
• gall bladder cancer (rare)

Outside the gall bladder:

• obstructive jaundice
• jaundice
• pancreatitis
• acute cholangitis
• bouvert’s (gastric outlet obstruction)
• Mirizzi (hepatic duct obstruction)

Question 6

Prognosis:

Answer 6

Gall stones do not usually cause symptoms