Gallstones

Question 1

what does bile contain?

Answer 1

• bile salts incl billirubin
• cholesterol
• lecithin

Question 2

what are the 3 main types of gallstone?

Answer 2

• cholesterol
• pigment
• mixed

Question 3

Risk factors?

Answer 3

Female

Fair

Fat

Fourty

Fertile

Question 4

Symptoms?

Answer 4

may be asymptomatic or, if obstruction:

• biliary colic which may radiate to back / shoulder tip
• biliary dyspepsia (indigestion from fatty foods)
• jaundice
• pruritus
• pale stools, dark urine

Question 5

signs?

Answer 5

• may be tenderness in RUQ
• bradycardia
  
  • due to inhibitory effects of bile salts on SA node

Question 6

Ix?

Answer 6

• LFTs
  
  • if obstruction: billirubin raised & aminotransferases mildly raised
  • raised ALP consistent w cholestasis
• US –> most sensitive initial test
  
  • can pick up 98% of stones in GB & 50% in CBD
• MRCP
• ERCP

Question 7

indications for MRCP?

Answer 7

indicated if USS doesnt show ductal stones but there is bile duct dilatation (upper limit of normal =6mm) OR raised billirubin

Question 8

indications for ERCP?

Answer 8

• established CBD stones (US+MRCP)
• obstructing ductal tumours

Question 9

Mx?

Answer 9

• Uncomplicated- conservative
  
  • fluids, analgesia etc
• Symptomatic in pt fit for surgery –> laparoscopic cholecystectomy
  
  • pts w cirrhosis / portal HT high risk of bleeding so best to do open surgery

Question 10

complications?

Answer 10

Gall bladder

• empyema
• mucocele
• perforation
• cholecystitis

Biliary tree

• cholangitis
• pancreatitis
• obstructive jaundice

Bowel

• gallstone ileus