Gallstones and Biliary Colic

Question 1

What are gallstones?

Answer 1

Cholelithiasis is the presence of solid concretions in the gallbladder. Gallstones form in the gallbladder but may exit into the bile ducts (choledocholithiasis).

Question 2

What is biliary colic?

Answer 2

Sudden RUQ pain due to gallstone presence in a bile duct

Question 3

Who gets gallstones and how often?

Answer 3

Cholelithiasis occurs in approximately 10% to 15% of adults in the US and Europe.

Obese and older people are more likely to get it

Question 4

What are the signs and symtpoms of gallstones?

Answer 4

RUQ pain > 30 mins
Postprandial pain
Nausea
Jaundice

Question 5

What are the risk factors of gallstones?

Answer 5

Common risk factors include older age, female sex and pregnancy, obesity, rapid weight loss, drugs, and a family history.

Question 6

What investigations might you do for gallstones?

Answer 6

Bloods- FBC, LFTs, lipase/ amylase (rule out other conditions such as pancreatitis)
Abdominal US

May consider MRCP, EUS, ERCP or Abdo CT

Question 7

What is the management of gallstones?

Answer 7

Cholecystectomy
ERCP with lithotripsy/ stent/ balloon dilation
Observation

Question 8

What are the complications of gallstones and their management?

Answer 8

ERCP related pancreatitis (bowel rest and analegsia)
BD injuries (stent)
Post sphincterotomy bleeding (Endoscopic haemostatic techniqures)
Bouveret syndrome
Gallstone ileus
Cholecystitis
Ascending cholangitis
Acute biliary pancreatitis
Mirizzi syndrome

Question 9

What is the prognosis of gallstones?

Answer 9

Often a recurring problem