Gallstones & Biliary Colic Flashcards
What are gallstones?
Stones forming in the gallbladder, typically of mixed composition or cholesterol.
What diseases can gallstones lead onto? (8)
Biliary Colic Acute Cholecystitis Gallbladder Abscess (Ascending) Cholangitis Acute Pancreatitis Gallstone Ileus Acalculous Cholesystitis Gallbladder Cancer
What is the most common disease caused by gallstones?
Cholecystitis
What is the epidemiology of gallstones?
Women (24%) > Men (12%)
What is the most common location of gallstones?
Common bile duct
Can be migratory or de novo
What disease occurs when gallstones are trapped in the common bile duct?
Biliary Colic
What are the classical symptoms of biliary colic?
Colicky right upper quadrant pain that occurs postprandially
Worse following fatty meals
Pain may radiate to the right shoulder/interscapular region
Nausea and vomiting are common
What are the investigations for gallstones?
Abdominal ultrasound
Liver function tests
(60% one abnormal LFT)
Where stones are suspected in the bile duct the options lie between magnetic resonance cholangiography (MRCP) and intraoperative imaging.
What is the treatment of gallstones?
Asymptomatic - common, treatment not required, only 2% progress
If in common bile duct increased risk of cholangitis and pancreatitis and surgery should be considered
Laparoscopic cholecystectomy + intraoperative cholangiography
(Frail - cholecystostomy)
If common bile duct stones are found - early ERCP in the day or so following surgery or immediate surgical exploration of the bile duct.
Small stones <5mm will mostly pass spontaneously.
What are the risks of ERCP?
Bleeding 0.9%
Duodenal perforation 0.4%
Cholangitis 1.1%
Pancreatitis 1.5%
What causes biliary colic?
Gallstones passing through the biliary tree
What are the risk factors for gallstones/biliary colic?
'4 Fs' Fat - increased cholesterol Female - 2-3 x more common, oestrogen related Fertile - Pregnancy risk factor Forty - Age
What other diseases are risk factors for gallstones/biliary colic?
Diabetes mellitus
Crohn’s disease
Rapid weight loss e.g. weight reduction surgery
Drugs: Fibrates, COCP
What is the pathophysiology of gallstone formation?
Increased cholesterol
Reduced bile salts
Biliary stasis
What causes the pain in biliary colic?
Due to the gallbladder contracting against a stone lodged in the cystic duct
What is the name of gallstones in the common bile duct and what condition can this cause?
Choledocholithiasis
Obstructive jaundice in some patients
What is gallstone ileus?
Small bowel obstruction secondary to an impacted gallstone
It may develop if a fistula forms between a gangrenous gallbladder and the duodenum
Abdominal pain, distension and vomiting are seen
What is acalculous cholecystitis?
Cholecystitis seen without gallstones, in patients with recurrent severe illness
Very ill - poor prognosis
What is the treatment of acalculous cholecystitis?
Cholecystectomy or percutaneous cholecystostomy
