Gallstones and biliary colic Flashcards
Basic anatomy
Right hepatic duct and left hepatic duct leave liver and become common hepatic duct
Cystic duct from gallbladder joins common hepatic duct halfway along
Pancreatic duct joins with common hepatic duct further along
Common bile duct and pancreatic duct join to become ampulla of Vater which opens to duodenum
Risk factors
Fat
Fair
Female
Forty
Presentation
Biliary colic
Present with complications
- acute cholecystitis
- acute cholangitis
- obstructive jaundice
- pancreatitis
Biliary colic
Fat entering digestive system cause cholecystokinin secretion from duodenum
CCK triggers contraction of gallbladder which leads to biliary colic
Patients advised to avoid fatty foods to prevent CCK release and gallbladder contraction
Bilirubin
Normally drains from liver, through bile ducts to intestines
Raised bilirubin with pale stools and dark urine represents obstruction to flow within biliary system
Obstruction may be caused by gallstone in bile duct or external mass pressing on bile ducts
Alkaline phosphatase
Non-specific marker
Enzyme originates in the liver, biliary system and bone
Often raised in pregnancy due to production by placenta
Aminortransferases
ALT and AST produced in the liver
Markers of hepatucellular injury
US
First-line investigation for symptoms of gallstone disease
Limited by patient’s weight, gaseous bowel obstructing the view and discomfort from the probe
US findings
Gallstones in gallbladder
Gallstones in ducts
Bile duct dilatation
Acute cholecystitis
Pancreas and pancreatic duct
MRCP
Used to investigate further if ultrasound scan doesn’t show stones in the duct but there is bile duct dilatation or raised bilirubin suggestive of obstruction
ERCP
Main indication is to clear stones in bile duct
Inject contrast and take x-rays to visualise biliary system
Perform sphincterotomy if its dysfunctional
Clear stones from ducts
Insert stents to improve bile duct drainage
Take biopsies of tumours
Key
complications of ERCP
Excessive bleeding
Cholangitis
Pancreatitis
Management
Asymptomatic with gallstones may be treated conservatively
Patients with symptoms or complications are treated with cholecystectomy
Cholecystectomy complications
Bleeding, infection, pain and scars
Damage to bile duct (leakage and strictures)
Stones left in bile duct
Damage to bowel, blood vessels or other organs
Anaesthetic risks
VTE
Post-cholecystectomy syndrome
Post-cholecystectomy syndrome
Diarrhoea
Indigestion
Epigastric or RUQ pain
Nausea
Intolerance of fatty foods
Flatulence
