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Z Year3 Gastro Conditions > Gallstones and Biliary Colic > Flashcards

Gallstones and Biliary Colic Flashcards

1
Q

Are gallstones common?

A

highly prevalent, but most cases are asymptomatic

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2
Q

What is biliary colic?

A

gallstones are symptomatic with cystic duct obstruction or if passed into common bile duct (CBD)

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3
Q

What are the risk factors for gallstones?

A
  1. Increasing Age
  2. Female sex
  3. Obesity diabetes and metabolic syndrome
  4. FHx of gallstones
  5. Gene mutations
  6. pregnancy/exogenous oestrogen
  7. non-alcoholic liver disease
  8. prolonged fasting/rapid weight loss
  9. total parenteral nutrition (TPN)
  10. medication
  11. terminal ileum disease or resection
  12. haemoglobinopathy
  13. Hispanic and Native-American ethnicity
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4
Q

What are the different types of stones in the biliary tract?

A
  1. Cholesterol gallstones
  2. Black pigment gallstones
  3. Brown pigment stones (ductal stones)
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5
Q

What are the most common type of stone?

A

90% of gallstones are made of cholesterol and formed in the gallbladder

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6
Q

What are pigment stones like and their causes?

A

small, friable and irregular (cause: haemolysis - calcium bilirubinate)

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7
Q

What are cholesterol stones like and their causes?

A

large often solitary (causes: age, sex, obesity)

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8
Q

What are the symptoms of gallstones like?

A
  1. right upper quadrant (RUQ) or epigastric pain (tenderness)
  2. Radiates to the right back or shoulder
  3. Responds to analgesia
  4. Typically occurs approximately 1 hour after consumption of food, often in the evening
  5. May wake the patient from sleep
  6. May be accompanied by nausea
  7. Becomes increasingly intense and then stabilises
  8. Typically lasts for at least 15 to 30 minutes and up to several hours.
  9. Sometimes Jaundice
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9
Q

What are some differential diagnosis of gallstones?

A
  1. Peptic ulcer disease (PUD)
  2. Gallbladder cancer
  3. Gallbladder polyps
  4. Acalculous cholecystitis
  5. Sphincter of Oddi dysfunction (SOD)
  6. Non-biliary acute pancreatitis
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10
Q

What are the first line investigations for gallstones?

A
  1. Abdominal US
  2. Serum LFTs
  3. FBC
  4. Serum lipase or amylase
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11
Q

How would cholelithiasis show in US?

A

stones in the gallbladder

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12
Q

How would choledocholithiasis show in US?

A

stones in the bile duct with or without bile duct dilation

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13
Q

How would serum LFTs look like in uncomplicated cholelithiasis?

A

normal

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14
Q

How would serum LFTs look like in choledocholithiasis?

A
  • elevated alkaline phosphatase

- elevated bilirubin

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15
Q

How would FBC look in different types of gallstones?

A
  1. normal WBC in simple (uncomplicated) biliary colic

2. elevated WBC in acute cholecystitis, cholangitis, or pancreatitis

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16
Q

Why do you measure serum lipase or amylase?

A

elevated (>3 times upper limit of normal) in acute pancreatitis

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17
Q

What other investigations would you consider?

A
  1. MRCP
  2. EUS
  3. Abdominal CT
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18
Q

What is the 1st line treatment of acute symptomatic cholelithasis?

A

1st line: Analgesia (NSAIDs)
Consider: Anti-spasmodic
Plus: cholecystectomy

19
Q

What is the 1st line treatment in choledocholithiasis with or without symptoms?

A

1st line: bile duct clearance and laparoscopic cholecystectomy
Plus: analgesia
Consider: anti-spasmodic

20
Q

What is the 2nd line treatment in choledocholithiasis with or without symptoms?

A

2nd line: temporary stenting prior to definitive biliary clearance
Consider: analgesia

21
Q

How would you treat ongoing asymptomatic cholelithiasis?

A

observation

22
Q

What are possible complications of gallstones?

A
  1. endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis
  2. iatrogenic bile duct injuries
  3. post-sphincterotomy bleeding
  4. Bouveret syndrome
  5. gallstone ileus
  6. acute cholecystitis
  7. acute cholangitis
  8. acute biliary pancreatitis
  9. Mirizzi syndrome
23
Q

How common is gallstones?

A
  • 8% of those over 40

- 90% remain asymptomatic

24
Q

What are features of symptomatic cholelithiasis?

A

post-prandial RUQ pain

25
Q

What is seen in US of symptomatic cholelithiasis?

A

stones in GB (acoustic shadow)

26
Q

What is the initial managemnt of symptomatic cholelithiasis?

A

IF SYMPTOMATIC

Analgesia

27
Q

What is the defintiive managemnt of symptomatic cholelithiasis?

A

Elective lap chole

28
Q

What are complications of symptomatic cholelithiasis?

A
  1. Biliary colic
  2. acute cholecysitis
  3. choledocholithiasis
29
Q

What are features of choledocholithiasis?

A

RUQ pain and sometimes jaundice

30
Q

What can be found in US for choledocholithiasis?

A

US: stones in CBD +/-dilated CBD

31
Q

What is the intial management of choledocholithiasis?

A

Analgesia
+
ERCP (regardless of symptoms)

32
Q

What is the defintive management of choledocholithiasis?

A

Elective lap chole

33
Q

What are complications of choledocholithiasis?

A
  1. Obstructive jaundice
  2. Acute cholangitis
  3. Pancreatitis
34
Q

What are RF for gallstones?

A
  1. Fair
  2. Fat
  3. Fertile (1 or more kids)
  4. Female
  5. Forty
  6. +OCC, Crohn’s
35
Q

What is cholelithiasis?

A

gallstone in gallbladder and if pain (bilary colic)

36
Q

What is acute cholecytsis?

A

Cholelithiasis + inflammation ±secondary infection

37
Q

Do you get jaundice in acute cholecystitis, cholelithiasis?

A

No Jaundice as not obstructing biliary flow but rarely, there can be mild jaundice in acute cholecystitis- inflammation of contiguous biliary ducts (Mirizzi’s syndrome)

38
Q

What is choledocholithiasis?

A

Gallstone in CBD (if with pain biliary colic)

39
Q

What is asceding cholangitis?

A

Choledocholithiasis + infection

40
Q

Is there jaundice in choledocholithiasis and ascending cholangitis?

A

May be jaundice/raised ALP/GGT

Obstruction to biliary flow

41
Q

What can a result of ERCP be?

A

ERCP can lead to pancreatitis in 3-5% of patients

42
Q

How do you Ix cholecystitis?

A

1st line: USS liver and biliary tree

43
Q

How do you tell the difference between biliary colic vs cholecystitis?

A

In cholecystitis signs of infection and inflammation: Fever, WCC/CRP and Murphy’s signs positive

44
Q

What are common complications of gallstones?

A
  • GB empyema

- Gallstone ileus

Z Year3 Gastro Conditions (48 decks)

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