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MRCS med school > Gallstones > Flashcards

Gallstones Flashcards

1
Q

Risk factors for Gallstones

A

Female

Fair

Forty

Fertile (pregnant, COCP)

Fat

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2
Q

Gallstone composition

A

Bile pigment stones 5%

Cholesterol stones 20%

Mixed stones 75%

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3
Q

Cholesterol gallstones

A

Large

Often solitary

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4
Q

Pigment gallstone

A

Small

Fragile

Calcium bilirubinate

Associated with haemolysis

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5
Q

Mixed gallstones

A

Often multiple

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6
Q

Complications of gallstones

A

Biliary colic

Acute cholecystitis

Chronic cholecystitis

Mirizzi’s syndrome

Obstructive jaundice

Pancreatitis

Cholangitis

Gallstone ileus

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7
Q

Biliary colic pathogenesis

A

Gallstone impacted in neck of gallbladder (Hartmann’s pouch)

Gallbladder spasm

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8
Q

Biliary colic presentation

A

RUQ pain - radiates to back / scapula

Attacks < 6 hrs

Worse with fatty food

Sweating

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9
Q

Investigations for biliary colic

A

Urine - bilirubin

Bloods

US - acoustic shadow

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10
Q

Management of biliary colic

A

Conservative: NBM + analgaesia + fluids

Surgical : laproscopic cholecystectomy

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11
Q

Acute cholecystitis pathogenesis

A

Gallstone impaction in Hartmann’s pouch+ inflammation+/- Empyema

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12
Q

Acute cholecystitis presentation

A

Contiuous RUQ pain (Radiates to right scapula + epigastrum)

Fever

Vomiting

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13
Q

Acute cholecystitis examination findings

A

Local peritonsim

RUQ

Tachycardia

Shallow breathing

Murphy’s sign

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14
Q

Acute cholecystitis investigations

A

Urine - bilirubin↑WCC

US

MRCP (MRI cholangiopancreatography)

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15
Q

Conservative management of acute cholecystitis

A

NBM + fluids

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16
Q

Medical management of acute cholecystitis

A

Analgesia

Abx: Cefuroxime + Metronidazole

17
Q

Surgical management of acute cholecystitis

A

Laproscopic cholecystectomy

18
Q

Acute cholecystitis empyema presentation

A

Fever

RUQ mass

19
Q

Chronic cholecystitis presentation

A

Vague upper abdo discomfort

Distention

Nausea

Flatulence

Worse with fatty food

20
Q

Chronic cholecystitis investigations

A

AXR

US - gallstones, fibrotic, shrunken gallbladder

MRCP

21
Q

Management of chronic cholecystitis

A

Medical: bile salts

Surgical: cholecystectomy

22
Q

Rarer gallstone disease

A

Mirizzi’s syndrome

Gallstone ileus

23
Q

Mirizzi’s syndrome

A

Rare

Large stone in gallbladder compresses common hepatic duct

Leads to obstructive jaundice

24
Q

Gallstone ileus

A

Rare

Large stone errodes from gallbladder to duodenum

May impact in distal ileum and cause obstruction

Rigler’s triad

25
Q

Rigler’s triad

A

Associated with gallstone ileus

Pneumobillia

Small bowel obstruction

Gallstone in RLQ

26
Q

Management of gallstone ileus

A

Stone removal via enterotomy

27
Q

Bilirubin level where jaundice is noticable

A

50 - 75 mM

Seen at tongue frenulum first

28
Q

Causes of obstructive jaundice

A

Stones

Cancer of pancreas head

Mirizzi’s syndrome

Drugs - COCP, sulfonylureas

29
Q

Obstructive jaundice presentation

A

Jaundice

Dark urine

Pale stools (steatorrhoea)

Itch

30
Q

Obstructive jaundice investigations

A

Urine - dark, bilirubin↑WCC

Hepatorenal syndrome↑conjugated bilirubin↑ALP and ↑AST/ALT↑INR (decreased vit K)

Immune: AMA, ANCA, ANA

AXR

US

MRCP

31
Q

Management of gallstone obstructive jaundice

A

Conservative:- Monitor LFTs and wait for stone passage

ERCP with sphincterotomy and stone extraction

Cholecystectomy

32
Q

Ascending cholangitis gallstone location

A

Common bile duct

33
Q

Ascending cholangitis presentation

A

Charcot’s triad

Reynolds pentad

34
Q

Charcot’s triad

A

Fever

RUQ pain

Jaundice

35
Q

Reynolds pentad

A

Charcot’s triad (Fever, RUQ pain, Jaundice)

+ shock

+ confusion

36
Q

Management of ascending cholangitis

A

Cefuroxime + Metronidazole

ERCP with sphincterotomy and stone removal

MRCS med school (44 decks)

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