Gallstones and cholecystitis Flashcards

1
Q

gallstones

A

may cause no Sx

occasionally discovered as incidental finding

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2
Q

epidemiology of gallstones

A

most common presentations:
biliary colic (56%) and acute cholecystitis (36%)
10-15% in the western world develop cholecystitis

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3
Q

cholecystitis

A

inflammation of the gallbladder

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4
Q

risk factors for gallstones

A

fair, fat, female, fertile, forty

also:
increasing age
FHx
sudden weight loss eg after obesity surgery
loss of bile salts eg after ileal resection, terminal illness
DM, as part of the metabolic syndrome
oral contraception (particularly in younger women)

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5
Q

types of stone

A

bile contains cholesterol, bile pigments and phospholipids

cholesterol stones: 80% of all in UK. large, often solitary and radiolucent
black pigment stones: small, friable (easily crumbled), irregular and radiolucent. risk factors include haemolysis
mixed stones are faceted and are comprised of calcium salts, pigment and cholesterol. 10% are radiopaque
brown pigment stones (<5% UK) form as a result of stasis and infection within the biliary system, usually in the presence of E. coli and Klebsiella spp.

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6
Q

presentation - gallstones

A

biliary colic most common

may also cause pancreatitis, obstructive jaundice

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7
Q

biliary colic

A

sudden RUQ/epigastric pain
may radiate around to the back in the interscapular region
often does not fluctuate, but persists anywhere from 15mins - 24h
subsides spontaneously or with analgesics
n&v often accompanies the pain

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8
Q

DDx

A
reflux
peptic ulcers
IBS
relapsing pancreatitis
tumours (stomach, pancreas, gallbladder)
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9
Q

investigations - gallstones

A

urinalysis, CXR and ECG may help rule others out
USS to demonstrate stones
LFTs
endoscopic retrograde cholangiopancreatography (ERCP) may be used for diagnosis, and also used for removal of stones

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10
Q

risk factors - cholecystitis

A
gallstones or biliary sludge (95% of patients)
hospitalisation for trauma or acute biliary illness
female
increasing age
obesity
rapid weight loss
pregnancy
crohn's
hyperlipidemia
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11
Q

presentation - cholecystitis

A

follows impaction of a stone on the cystic duct
may cause continuous epigastric or RUQ pain, vomiting, fever, local peritonism, GB mass
main difference to gallstones is the inflammatory component (local peritonism, fever, raised WCC)
if the stone moves to the CBD, jaundice may occur
murphy’s sign

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12
Q

murphy’s sign

A

lay 2 fingers over the RUQ
ask patient to breathe in
causes pain as the inflammed gallbladder is pressed down onto fingers
only positive if similar movement in LUQ does not cause pain

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13
Q

chronic cholecystitis

A

repeated attacks of acute cholecystitis lead to chronic
walls of GB become thickened and scarred
GB becomes shrivelled

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14
Q

investigations - cholecystitis

A

FBCs (raised WCC)
LFTs
USS - thickened GB wall (>3mm), maybe pericholecystic fluid or air in GB or GB wall

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15
Q

pancreatitis

A

passage of gallstone into the bowel can temporarily block the biliopancreatic duct
leads to premature release of enzymes

Sx:
persistent epigastric pain
radiates to the back
relieved by sitting forwards
profuse vomiting
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