Gallstones Flashcards
Gallstone types
Pigment stones due to haemolysis
Cholesterol stones in forty, female, fat
Gallstone presentations
Biliary colic Acute cholecystitis Chronic cholecystitis Obstructive with CBD stones Cholangitis Gallstone ileus Pancreatitis
Biliary colic symptoms
Cystic duct obstruction causes RUQ pain radiates to back ± jaundice
Biliary colic treatment
Analgesia
Rehydrate
NBM
Elective cholecystectomy early to prevent complications e.g. acute pancreatitis
Acute cholecystitis symptoms and signs
Impaction in gallbladder neck causes epigastric/RUQ pain, vomiting, fever, local peritonism
Murphy’s sign
Phlegmon (RUQ mass of omentum) palpable
Murphy’s sign
2 fingers over RUQ, on inspiration pt stops inspiring due to pain of palpable GB
Only + test if LUQ same test doesn’t cause pain
Acute cholecystitis tests
Inc WCC
US shows thick walled, shrunken GB, dilated CBD, pericholecystic fluid
Acute cholecystitis treatment
NBM
Analgesia
ABX e.g. co-amoxiclav 625mg/8h
Laparoscopic cholecystectomy or open if GB perforation, done under local if GA not tolerated
Chronic cholecystitis presentation
Chronic inflammation ± colic
Flatulent dyspepsia
Fat intolerance
Chronic cholecystitis tests
US assesses CBD diameter/stone position
MRCP to find stones
Chronic cholecystitis treatment
Cholecystectomy
Obstructive jaundice with CBD stone treatment
ERCP with sphincterotomy ± biliary trawl
Cholecystectomy if needed, CBD stones identified pre-op with MRCP
Cholangitis presentation
Bile duct infection shows Charcot’s triad - RUQ pain, jaundice, rigors
Cholangitis treatment
Piperacillin/tazobactam 4g/0.5g /8h IV
Gallstone ileus pathology
Stone erodes through GB into duodenum, can obstruct there (Bouveret’s syndrome, rare) or terminal ileum
