Gallstones and Biliary Colic Flashcards
What causes biliary colic?
Gallstones passing through the biliary tree
What are the risk factors for gallstones?
4Fs
- Fat
- Female
- Fertile
- Forty
Why is obesity a RF?
enhanced cholesterol synthesis and secretion
Why is being female a RF?
Oestrogen increases activity of HMG-CoA reductase
What are other RFs for gallstones?
DM
Crohn’s
Rapid weight loss e.g. bariatric surgery
Drugs (fibrates, OCP)
Outline the pathophysiology for gallstones?
occur due to ↑ cholesterol
↓ bile salts and biliary stasis
the pain occurs due to the gallbladder contracting against a stone lodged in the cystic duct
What are the presenting features of biliary colic?
colicky right upper quadrant abdominal pain
worse postprandially
worse after fatty foods
can be worse at night when laying flat
the pain may radiate to the right shoulder/interscapular region
nausea and vomiting are common
What is the investigation for gallstone-related disease?
US
How are gallstones managed?
Elective laparoscopic cholecystectomy
What are gallstones in the CBD called?
Choledocholithiasis
What are the possible complications of gallstones?
acute cholecystitis: the most common (galbladder inflammation) complication ascending cholangitis acute pancreatitis gallstone ileus gallbladder cancer
Describe the process of bile release
high fat
Enteroendocrine cells secrete CCK into bloodstream which go to gallbladder
Stimulates bile release
What are some risks of ERCP?
Bleeding 0.9%
Duodenal perforation 0.4%
Cholangitis 1.1%
Pancreatitis 1.5%
What are the features of acute cholecystitis?
Right upper quadrant pain
Fever
Murphys sign on examination
Occasionally mildly deranged LFT’s
What are features of gallbladder abscess?
Usually prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell
Generalised peritonism not present
