Gallstones and Biliary colic Flashcards
state typical presentation of gallstones and biliary colic?
stabbing colicky pain- worse after eating and nausea and vomiting
define gallstones and biliary colic
stone formation in gallbladder
cholelithiasis= presence of gallstones in gall bladder
right upper quadrant or epigastric tenderness - due to an obstruction of the gallbladder or common bile duct usually due to a gallstone blocking one of the bile ducts. Contractions of biliary tree to relieve obstruction. The pain can be poorly localised due to its visceral nature.
what are the risk factors for gallstones?
– 6Fs
Fair (Caucasian)
Fat
Fertile
Forty
Female
Family history
Others: Diabetes mellitus, Drugs (OCP, octreotide)
Pigment Stone Risk Factors: haemolytic disorders (e.g. sickle cell anaemia
which drugs are known to cause gallstones?
Cluvanic acid
Penicillins
Oestrogens
Erythromycin
Chlorpromazine
what are the symptoms of gallstones?
- sudden onset severe
- RUQ pain
- Post prandial-> after fatty meal
- Colicky
- Nausea
can lead to cholecystitis- inflammation of gallbladder-> see symptoms
- Systemically unwell
- Fever
- Prolonged upper abdominal pain that may be referred to the right shoulder (due to diaphragmatic irritation) and is exacerbated by movement and resp
can lead to ascending ( acute) cholangitis- inflammation common bile duct -> see symptoms
- Charcot’s triad: RUQ pain, jaundice and rigors
- If combined with hypotension and confusion, known as Reynold’s pentad.
what are the signs of gallstones on physical examination ?
Biliary colic- RUQ pain and tenderness
Acute cholecystitis signs – the main difference from 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
- NOTE: this is only positive if the same test in the LUQ does not cause pain
Acute cholangitis signs (Charcot’s triad)
- Pyrexia with rigors
- RUQ pain
- Jaundice
what is Murphys sign
what are the appropriate investigations for gallstones?
FBC - high WCC in cholecystitis and cholangitis
LFT - high ALP + GGT in ascending cholangitis
Amylase (exclude pancreatitis)
ULTRASOUND OF BILIARY TREE= GOLD STANDARD
What is seen on an abdominal ultrasound in gallstones?
- Shows gallstones
- Increased thickness of gallbladder wall (>3mm) – indicates cholecystitis
- Dilatation of biliary treeindicative of obstruction
what are the 2 important complications of gallstones?
what is the management plan for gallstones?
Cholelithiasis= Cholecystectomy
Choledocholithiasis= ERCP
what are the symptoms of acute cholecystitis?
ConstantRUQ pain–> May radiate to R scapula (Boas’ sign)
Fever
Nausea & vomiting
Rebound tenderness
Murphy’s sign +
what are the symptoms of acute cholangitis?
Charcot’s triad
- RUQ pain
- Fever
- Jaundice
If septic: Reynold’s pentad
- RUQ pain
- Fever
- Jaundice
- Hypotension
- Confusion
summarise the prognosis of patients with gallstones?
Gallstones do NOT cause symptoms most of the time
Surgery offers an excellent chance of cure if they were to become symptomatic
