Gallstones and biliary colic Flashcards
What are gallstones?
Gallstones are solid deposits, often of cholesterol or bilirubin (a pigment), that form within the gallbladder, a small organ responsible for storing bile. These stones may range from the size of a grain of sand to larger than a golf ball
What causes gallstone formation?
The formation of gallstones is primarily associated with three factors:
- Super-saturation of bile with cholesterol
- Gallbladder dysmotility leading to stasis
- Excessive bilirubin excretion
What are the different types of gallstones a pt could have?
There are three types of gallstones:
- Pigment (<10%) Associated with haemolysis, stasis and infection.
- Cholesterol (90%) Associated with female sex, increasing age and obesity.
- Mixed
What are the risk factors for gallstones?
Risk factors for developing gallstones include:
- Obesity
- Female sex
- Diabetes
- Family history
- Chronic loss of bile salts (e.g., terminal ileal disease, Crohn’s disease)
- Oral contraceptive pill
- Pregnancy
- Rapid weight change (e.g., bariatric surgery)
- Chronic haemolysis (e.g., sickle cell anaemia, G6PD deficiency)
- Increasing age
The 4F’s: ‘fair, fat, female and forty’ is often used to remember these risk factors
What are the signs/ symptoms associated with gallstones or biliary colic?
- Colicky RUQ pain
- Individuals may present with pain following ingestion of a fatty meal - Nausea and vomiting
- Pain may radiate to the right scapula
- Murphy’s Sign Negative
[NOTE: no juandice- unlike cholangitis]
What investigations are used to diagnose/ monitor gallstones?
- Basic blood panel: Raised liver function tests and C-reactive protein.
- Ultrasound: First-line imaging; detects bile duct dilatation but less effective for mid/distal stones.
- CT scan: Provides detailed anatomy of the biliary tree, better visualization of radiopaque stones. (but will not add much to any US findings; in that case MRCP next to reduce further radiation)
- MRCP (Magnetic resonance cholangiopancreatography): Most accurate for detecting gallstones or strictures, provides detailed view of biliary blockage. Use if there is common bile duct dilation
- ERCP (Endoscopic retrograde cholangiopancreatography): Used for therapeutic intervention once aetiology is confirmed.
How are gallstones managed?
- Resuscitation: Intravenous fluids and antibiotics, critical care if necessary.
- Biliary drainage: Via endoscopic (ERCP), percutaneous (PTC), or surgical means.
- Addressing the underlying cause: e.g., cholecystectomy for gallstones, further investigation and treatment for malignant strictures
What is biliary colic?
- Pain resulting from obstruction of the gallbladder or common bile duct, usually by a stone
What causes biliary colic?
- Occurs due to contractions of the biliary tree in an attempt to relieve an obstruction (e.g. due to a stone)
- Biliary Colic is most common presentation of gallstone disease
What are the presenting symptoms of biliary colic?
- sudden onset
- severe RUQ or epigastric pain, constant in nature.
- May radiate to right scapula, often precipitated by a fatty meal.
- Can last hours, may be associated with nausea and vomiting.
- May have sweating, fever BUT usually they are systemically well
What signs of biliary colic can be found on physical examination?
- RUQ or epigastric tenderness that radiates to the right shoulder
- biliary colic is the inflammatory component
- Tachycardia
- Pyrexia
- Local peritonism
- RUQ pain or epigastric tenderness
- May be guarding and/or rebound tenderness
- Murphy’s sign positive
What investigations are used to diagnose/ monitor biliary colic?
- Based on RECURRENT symptoms
- confirmed on ultrasound
How is biliary colic treated?
- Manage pain & other symptoms:
- Analgesia
- IV fluids
- NBM - Surgical → Elective Laparoscopic Cholecystectomy
- ERCP can also be used to help remove stones or stent a blocked bile duct
What complications may arise from gall stones/ biliary colic?
acute cholecystitis, ascending cholangitis, acute pancreatitis, gallstone ileus (pneumobilia = air in biliary tree on CXR + SBO), gallbladder cancer
