GALLSTONES Flashcards
What is Gallstones?
Presence of solid concretions in the gallbladder or the biliary tree
What are the cystic duct obstructions called?
Biliary Colic - temporary
Acute Cholecystitis - persistent
What are the obstructions of the common bile duct called?
Cholangitis
Choledocholithiasis
What are the symptoms of Bile Obstructions?
Abdominal pain Nausea and Vomiting Anorexia Peritoneal irritations Fever Flatulences and Fat intolerance (Chronic Cholecystitis)
What are the signs of bile duct obstructions?
Severe dull RUQ pain radiating to right shoulder or back
Palpable mass
Arrest respiration on palpation
Murphy’s Sign (pain upon deep inspiration when had is resting on costal margin)
How does Biliary colic differ from Cholecystitis in presentation?
No fever
Pain constant for only 1-5hrs and provoked by fatty meal
Normal inflammatory markers
How does Cholangitis symptoms present?
Fatigue Pruritus Pale stools Dry eyes and mouth Char it’s Triad (Fever, Jaundice, Abdominal Pain)
What are the physical signs of Cholangitis?
Charcot’s Triad (RUQ pain, Jaundice, Fever)
Splenomegaly
Ankle oedema
Ascites
What are the 4F for risk factors of Gallstones?
Female
Fertile
Forty
Fat
How is gallstones investigated with blood test?
LFT: high ALP and ALT and Bilirubin
FBC: high WCC
U&E: high creatinine and Urea (Cholangitis)
CRP: high
Which scan would you do to investigate Gallstones?
Abdominal ultrasound - This will reveal a stone
MRCP - if no stone is found in ultrasound but bile duct is dilated and/or LFT abnormal
Endoscopic Ultrasound - if MRCP doesn’t allow diagnosis
How is Gallstones treated?
IV fluids, Paracetamol, analgesia and antibiotic (if sepsis suspected)
Give IV metronidazole for Cholangitis
Laparoscopic Cholecystectomy or ERCP
