Gallstones

Question 1

What is biliary colic?

Answer 1

Occurs when the gallbladder neck becomes obstructed by a gallstone. There is no inflammatory response, yet the contraction of the gallbladder against the occluded neck will result in pain.

Question 2

What is acute cholecystitis?

Answer 2

Acute gallbladder inflammation usually caused by impaction of a gallstone in wall, often causing cystic duct obstruction

Question 3

What are types of gallstones and what causes them?

Answer 3

Cholesterol: poor diet, obesity

Pigmented: bile pigments e.g. haemolytic anaemia

Mixed

Question 4

What are rick factors for getting gallstones?

Answer 4

• Females
  
  • Fertile
  • Overweight
  • Fertile
  • 40
  • Pregnancy
  • Oral contraceptive pill
  • Haemolytic anaemia
  • Malabsorption

Question 5

What are Sx of biliary colic?

Answer 5

Cramping pain in RUQ precipitated by eating fatty foods, radiating to back

Nausea and vomiting

Relieved by analgesia

Question 6

What are Sx of acute cholecystitis

Answer 6

Constant RUQ/epigrastric pain

Fever, lethargy,

Murphy’s sign

Question 7

What is acute cholangitis?

Answer 7

Infection of the biliary tract caused by biliary outflow obstruction and infection

Question 8

What are causes of acute cholangitis?

Answer 8

• Gallstones moving to CBD
• ERCP
• Cholangiocarcinoma
PSC

Question 9

What are Sx of acute cholangitis?

Answer 9

Charcot’s triad: severe RUQ pain, swinging fever, obstructive jaundice

Question 10

What are differentials for gallstones?

Answer 10

GORD
PUD
Acute pancreatitis
IBD

Question 11

What Ix in gallstones?

Answer 11

Bloods: CRP/WCC raised.
LFTs: colic and cholecystitis will show raised ALP but normal bilirubin. Cholangitis will have obstructive jaundice.

Amylase should be done to exclude pancreatitis

Imaging: US. Can show stones, wall thickening, bile duct dilation.

If US inconclusive, do MRCP or ERCP

Question 12

What is Rx of biliary colic?

Answer 12

Analgesia: paracetamol+ NSAIDs, lifestyle modification (diet)

Cholecystectomy within
6 weeks due to high rate of recurrence

Question 13

What is Rx of acute cholecystitis?

Answer 13

IV Abx.

Cholecystectomy in 3-7 days.

If not fit for surgery, percutaneous cholecystostomy

Question 14

What is Rx of CBD stones?

Answer 14

ERCP with stone removal, followed by cholecystectomy

Question 15

What are complications of gallstones?

Answer 15

Gallstone pancreatitis

Gallstone ileus: following fistula. Need laparotomy.

Cholangitis

Mirizzi syndrome

Empyema: cholecystectomy

Question 16

What is Rx of cholangitis?

Answer 16

Endoscopic biliary decompression e.g. ERCP with or without sphincterotomy and stenting.