Gallstones Flashcards
What are the main types of gallstones?
Cholesterol stones
- purely cholesterol
- excess cholesterol production
Pigment stones
- purely bile pigments
- commonly seen in those with haemolytic anaemia
Mixed stones
- comprised of both cholesterol and bile pigements
Risk factors of gallstones
Female Diabetes Obesity Pregnancy Oral contraceptive
What is biliary colic?
Neck of gallbladder is impacted by a stone, contraction of gallbladder causes pain
Clinical features of biliary colic
Intermittent colicky pain
Pain precipitated by fatty foods
What is acute cholecystitis?
Impaction of stone with signs of inflammation
Clinical features of acute cholecystitis
Constant pain - RUQ + epigastric
Pain radiates to back
Fever
N+V
What is Murphy’s sign?
Apply pressure in RUQ
Ask patient to inspire
Positive = halt in inspiration due to pain
Sign of an inflammed gallbladder
Investigations for biliary colic/acute cholecystitis
Urinanalysis - rule out renal cause/pregnancy Bloods - FBC - CRP - LFT (raised ALP) Ultrasound MRCP
Management of biliary colic
Analgesia
Low fat diet
Cholecystectomy
Management of acute cholecystitis
Antibiotics
Fluids
Analgesia
Cholecystectomy
Complications of biliary colic/acute cholecystitis
Gallbladder empyema Chronic cholecystitis Gallbladder-duodenum fistula Bouveret's syndrome Gall stone ileus
What is gallbladder empyema?
Gallbladder is infected and abscess forms inside
Diagnosed by ultrasound or CT
Management: cholecystectomy
What is chronic cholecystitis?
Recurrent/untreated cholecystitis
Ongoing RUQ/epigastric pain
Diagnosed by CT
Management: cholecystectomy
What is Bouveret’s syndrome?
Gallstone passes into duodenum and causes obstruction
What is Gallstone illeus?
Gallstone passes into bowel and causes obstruction at terminal illeum
What is cholangitis?
Infection in biliary tract
Cause of cholangitis
Combination of biliary outflow obstruction and biliary infection
Stasis of fluid allows bacterial colonisation
What are the common organisms of cholangitis?
Escherichia Coli
Klebsiella species
Enterococcus
Clinical features of cholangitis
RUQ pain
Fever
Jaundice
Previous gallstones
What is Charcots triad?
Jaundice
Fever
RUQ pain
Associated with cholangitis
What is Reynold’s pentad?
Jaundice Fever RUQ pain Hypotension Confusion
Associated with cholangitis
Management of cholangitis
Definitive treatment:
- endoscopic biliary decompression
Beware of sepsis
What is choledocholithiasis?
Gallstones impacted in common bile duct
Clinical features of choledocholithiasis
Jaundice
Tachycardia
RUQ pain
Fever
