Gallstones and Cholecystitis

Question 1

Gallstones and Cholecystitis Epidemiology

Answer 1

• 1-4% of asymptomatic patients will develop symptoms
• 10-15% of the adults world develop gallstones
• Increasing age, sudden weight loss, FFFF

Question 2

Gallstones Types of Stone

Answer 2

• Bile contains cholesterol, pigments, phospholipids
• Cholesterol are 80%
• Black pigment stones are small, friable, irregular and radiolucent (haemolysis, cirrhosis are RFs)
• Mixed
• Brown pigment stones

Question 3

Gallstones Presentation

Answer 3

• 70% asymptomatic
• Biliary colic most common presentation, sudden RUQ pain can radiate to back, often does not fluctuate but persists 15 minutes up to 24 hours
• Caused by impaction in cystic duct or ampulla of Vater
• Second most common presentation is acute cholecystitis caused by distension with necrosis

Question 4

Gallstones Differentials

Answer 4

• Reflux
• Peptic ulcer
• IBS
• Pancreatitis
• Neoplasm

Question 5

Gallstones Ix

Answer 5

• FBCs (WCC), LFTs, lipase
• USS
• If strongly suggestive but USS negative; consider further imaging

Question 6

Cholecystitis RFs

Answer 6

• Gallstones in 95%

- Hospitalisation for trauma

Question 7

Cholecystitis Presentation

Answer 7

• Main difference from biliary colic is inflammatory component
• If stone moves to CBD, jaundice may occur
• Murphy’s sign

Question 8

Cholecystitis Ix

Answer 8

• FBC, LFTs, RUQ

- USS

Question 9

Gallstones and Cholecystitis Management

Answer 9

• Many can be managed at home
• Morphine or pethidine
• Those who require antibiotics should have them in hospital
• Early cholecystectomy is not recommended in multi-organ disease
• Indicated in acute
• ERCP if in bile duct, removal if in