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GIT (Joyce) > Gallstones (cholelithiasis + choledocholithiasis) > Flashcards

Gallstones (cholelithiasis + choledocholithiasis) Flashcards

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1
Q

What different kinds of gallstones can be formed from the various bile components?

A
  • Cholesterol stones (>80%)
  • Pigment salt stones (calcium) bile salts
  • Mixed
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2
Q

Risk factors for cholesterol stones

A

4Fs = fat, forty, female, fertile (oestrogens)

  • diet
  • impaired GB emptying (TPN, DM…)
  • rapid weight loss (cholesterol liberated from fat stores)
  • terminal ileal resection/disease
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3
Q

Admirand’s triangle = high risk of gallstones if:

A
  • ↓lecithin
  • ↓bile salts
  • ↑cholesterol
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4
Q

Risk factor for pigment stones

A

haemolysis

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5
Q

Standard tests ordered in suspected biliary pain?

A
  • Standard bloods (FBE, UEC, LFTs, lipase)
  • U/S
  • ERCP
  • MRCP
  • PTC (percutaneous transhepatic cholangiography)
  • HIDA scan
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6
Q

define:

(1) cholelithiasis
(2) biliary colic
(3) acute cholecystitis
(4) chronic cholecystitis
(5) acalculous cholecystitis
(6) choledocholithiasis
(7) cholangitis

A

(1) stones in GB
(2) stones transiently in cystic duct (no infx)
(3) GB inflammation due to prolonged stone impaction in cystic duct
(4) longstanding GB inflammation
(5) GB inflammation w/o stone (usually ischemic/stasis)
(6) stones in the CBD
(7) infx/inflammation of biliary tree

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7
Q

What % gallstones (cholelithiasis) are asymptomatic?

A

> 80%

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8
Q

Risk factors for symptoms (2)

A

smoking

parity

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9
Q

Biliary colic Px

A
  • constant epigrastric/RUQ pain lasting mis-hours (may radiate to back/shoulder, associated w. food, esp. fatty meals, often at night)
  • pts often restless
  • no peritoneal involvement

(may px as chest pain)

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10
Q

How is biliary colic Dx?

A

Normal bloods

U/S shows cholelithiasis (+/- stone)

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11
Q

How is it Rx?

A

Analgesia
Rehydration
Often self-resolving

+/- elective cholecystectomy

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12
Q

Acute cholecystitis clinical Px

A
  • constant epigrastric/RUQ pain lasting lasting hours-days
  • peritoneal signs (Murphey’s sign)
  • Systemic signs (anorexia, N/V, low grade fever)
  • may have Hx biliary colic
  • may feel inflamed phegmon
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13
Q

Acute cholecystitis clinical Px

A
  • constant epigrastric/RUQ pain lasting lasting hours-days
  • peritoneal signs (Murphey’s sign)
  • Systemic signs (anorexia, N/V, low grade fever)
  • may have Hx biliary colic
  • may feel inflamed phlegmon
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14
Q

Acute cholecystitis Dx

A
  • Standard bloods (leukocytosis, elevated bili/AST/ALT/ALP)
  • US (thick wall, shrunken GB, pericholecystic fluid, stones, CBD > 6mm)
  • Consider HIDA if -ve US
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15
Q

Acute cholecystitis Rx

A
  • Analgesia
  • Hydration
  • Abx (cephzolin)
  • Consider cholecystectomy
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16
Q

Acute cholecystitis Cx

A
  • GB empyema
  • GB mucocele (after cystic duct obstruction)
  • Gangrene / perforation
  • Cholecystenteric fistula (–> gallstone ileus)
  • Emphysematous cholecystitis (gas produced by bacteria)
  • Mirizzi syndrome (large stone in cystic duct –> compresses CBD/CHD)
17
Q

Cx cholecystectomy

A
  • pancreatitis
  • CBD injury
  • bile peritonitis
  • hollow viscus/vessel injury
18
Q

Cx cholecystectomy

A
  • pancreatitis
  • CBD injury
  • bile peritonitis
  • hollow viscus/vessel injury
19
Q

Chronic cholecystitis clinical px

A
  • Flatulant dyspepsia
  • Vague abdominal discomfort
  • Distention, N/V, fat intolerance
20
Q

Chronic cholecystitis Dx

A

US/MRCP = stones
US = CBD > 6mm
ERCP + sphincterotomy = before surgery

21
Q

Chronic cholecystitis Rx

A

Cholecystectomy

22
Q

Acalculous cholecystectomy Px

A
  • Most asymptomatic
  • As acute cholecystitis

(biliary pain for hours-days, anorexia, N/V, low-grade fever +/- inflamed phlegmon)

23
Q

Acalculous cholecystctomy Rx

A

Broad spectrum ABX

Cholecystectomy

24
Q

Choledocholithiasis clinical px

A
  • 50% asymptomatic
  • biliary pain (usually no radiation to shoulder)
  • alcoholic stool
  • obstructive jaundice
25
Q

primary vs. secondary choledocholithaisis

A

Primary = formed in CBD (indicates CBD pathology - e.g. stricture)

Secondary = stone from GB (85%)

26
Q

Choledocholithaisis Dx

A
  • Basic bloods (normal FBE/lipase, abnormal LFTs)
  • U/S = ductal dilation
  • ERCP/MRCP/PTC
27
Q

Choledocholithiasis Rx

A
  • ERCP to remove sone

* Cholecystctomy

28
Q

Choledocholithiasis Cx

A

Pancreatitis
Cholangitis
Biliary strictures
Biliary cirrhosis

29
Q

Choledocholithiasis Cx

A

Pancreatitis
Cholangitis
Biliary strictures
Biliary cirrhosis

30
Q

ERCP cx

A
  • trauma pancreatitis (1-2%)

* pancreatic/biliary sepsis

31
Q

ERCP cx

A
  • trauma pancreatitis (1-2%)

* pancreatic/biliary sepsis

32
Q

Why is a UEC performed in biliary pain?

A

Pt may require imaging w. contrast

33
Q

Why is a UEC performed in biliary pain?

A

Pt may require imaging w. contrast

34
Q

One key advantage of ERCP over MRCP

A

ERCP can be therapeutic (to remove stones from CBD). MRCP is never therapeutic

35
Q

One key advantage of ERCP over MRCP

A

ERCP can be therapeutic (to remove stones from CBD). MRCP is never therapeutic

36
Q

When would a PTC (percutaneous transhepatic cholangiography) be performed?

A

Failed ERCP

Proximal bile duct lesions

GIT (Joyce) (2 decks)

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