Gallstones (Cholelithiasis) Flashcards
what is the definition of gallstones?
Cholelithiasis is the presence of solid concretions in the gallbladder. Gallstones form in the gallbladder but may exit into the bile ducts (choledocholithiasis).
Symptoms ensue if a stone obstructs the cystic, bile, or pancreatic duct.
what is the epidemiology of gallstones?
Gallstones are the most common gastrointestinal disease that requires hospitalisation in developed countries
Very common: 1/3 women over 60
70% Cholesterol, 30% pigment+/- calcium
what is the aetiology of gallstones?
Ninety percent of gallstones are composed of cholesterol; these form in the gallbladder.
Some risk factors for the development of cholesterol gallstones are modifiable, such as obesity, total parenteral nutrition, rapid weight loss after bariatric surgery, and medications (e.g., oestrogen, octreotide, ceftriaxone). Others, such as age, genetic factors, and female sex, are immutable. Cholesterol stones form in the gallbladder but can then migrate into the common bile duct, as occurs in 10% to 15% of patients presenting for cholecystectomy
what are the risk factors for gallstones?
liver disease, ileal disease, TPN, clofibrate
increasing age
female sex
obesity, diabetes, and metabolic syndrome
family history of gallstones
what is the pathophysiology of gallstones?
Most gallstones in developed countries (>90%) consist of cholesterol.
Cholesterol gallstone formation begins with the secretion of bile supersaturated with cholesterol from the liver. Initiated by nucleating factors such as mucin, microscopic crystals then precipitate in the gallbladder where hypomotility provides time for stone growth.
what are the key presentations of gallstones?
Most are asymptomatic
right upper quadrant or epigastric pain (typically lasting >30 minutes)
presence of risk factors
what are the signs of gallstones?
Cholecystitis Cholangitis Pancreatitis Obstructive jaundice Weight loss and jaundice can present as gallstones as well as malignancy
what are the symptoms of gallstones?
Biliary pain postprandial pain right upper quadrant or epigastric tenderness nausea jaundice
what are the first line and gold standard investigations of gallstones?
abdominal ultrasound - presence of infection and stones in GB
serum LFTs - ALT raised, bilirubin high
FBC
serum lipase or amylase - high amylase
what other tests could be done for gallstones?
magnetic resonance cholangiopancreatography (MRCP) - stones in GB
endoscopic ultrasound scan (EUS)
abdominal CT scan
what are the differential diagnoses for gallstones?
Peptic ulcer disease (PUD)
Gallbladder cancer
Gallbladder polyps
how is gallstones managed?
- conservative management
- Radiological drain
- ERCP
- Laparoscopic cholecystectomy - last option, key hole
- Bile acid dissolution therapy (<1/3 success)
how is gallstones monitored?
Patients who experience therapy-related complications require follow-up with their physicians. There are no recommended secondary preventive measures
what are the complications of gallstones?
Complications such as cholecystitis, cholangitis, and pancreatitis develop in 0.1% to 0.3% of patients annually
what is the prognosis of gallstones?
The outlook for patients with symptomatic cholelithiasis managed by cholecystectomy is favourable
