Gallstones Disease

Question 1

Name given to the intermittent wave of RUQ/epigastric pain that occurs when the gallstones becomes stuck in the gallbladder neck or cystic duct?

Answer 1

Biliary colic

Question 2

Enzyme produced by the duodenum that stimulates the gallbladder to contract after eating (especially. fatty food)

Answer 2

Cholecystokinin (CCK)

Question 3

Name the disease that occurs when a gallstone gets stuck in the gallbladder neck or cystic duct and becomes infected

Answer 3

Acute cholecystitis

Question 4

Main 2 symptoms of Acute Cholecystis?

Answer 4

Pain (biliary colic)

Fever

Question 5

Other symptoms of Acute Cholecystitis? (2)

Answer 5

Nausea/Vomiting 
Back pain (radiation)

Question 6

What is Murphy’s sign? What does it show?

Answer 6

1. Pain on deep inspiraition when the RUQ is palpated

2. Positive for Acute Cholecystis

Question 7

Investigations for Acute Cholecystitis?

Answer 7

1. Bloods: FBC, LFTs, CRP

2. Abdominal USS

Question 8

What can you do if the Abdominal USS is inconclusive but there is still a high suspicion of gallstones?

Answer 8

MRCP

Question 9

What happens to each of these markers in Acute Cholecystitis?

• WBC
• CRP
• AST/ALT
• ALP, GGT, bilirubin

Answer 9

WBC = raised
CRP = raised
AST/ALT = normal
ALP, GGT, bilirubin = normal (1/3rd can have raised markers - stone in CBD)

Question 10

Risk factors for gallstones (5)

Answer 10

Fat 
Female 
Fertile 
Forty (young women) 
Fair (Caucasian) 

EXTRA: FOOD - Family history, OCP, Old age, Diabetes

Question 11

Management of Acute Cholecystisis? (6)

Answer 11

1. IV fluids
2. Abx
3. Analgesia
4. Antiemetics
5. Laparoscopic Cholecystectomy
6. +/- ECRP clearance of CBD

Question 12

What would the abdominal USS show in Acute Cholecystitis? (3)

Answer 12

1. Thickened gallbladder walls
2. Gallstones or sludge in gallbladder
3. Duct dilatation

Question 13

What is gallbladder sludge?

Answer 13

Early signs of gallstones formation.

Question 14

What are the 3 main types of gallstones?

Answer 14

1. cholesterol stones (most common - 80% of cases)
2. (Bile) Pigment stones
3. Mixed cholesterol/pigments

Question 15

Complications that can arise from Acute Cholecystitis?

Answer 15

1. Mirizzi Syndrome
2. Chronic cholecystitis
3. Gallbladder empyema (pus)

Question 16

What is Mirizzi syndrome?

Answer 16

Large gallstone in the gallbladder neck that compresses on the hepatic bile duct, causing obstructive jaundice.

Question 17

Problem with Chronic Cholecystitis?

Answer 17

Persistent inflammation of the gallbladder wall can cause fibrosis, carcinoma or a biliary-enteric fistula

Question 18

Name the disease that occurs when a gallstone gets stuck in the common bile duct (CBD) and becomes infected

Answer 18

Acute (ascending) Cholangitis

Question 19

Other causes of Acute Cholangitis other than gallstones? (2)

Answer 19

1. ERCP

2. Cholangiocarcinoma

Question 20

What is Charcot’s triad? What condition does it present in?

Answer 20

Biliary colic (pain) + Fever + Jaundice

Question 21

What is Reynolds’ Pentad? What condition does it present in?

Answer 21

Biliary colic + Fever + Jaundice + Hypotension + Confusion

Question 22

What happens to each of these markers in Acute Cholecystitis?

• WBC
• CRP
• AST/ALT
• ALP, GGT, bilirubin

Answer 22

WBC: raised
CRP: raised
AST/ALT: normal
ALP, GGT, Bilirubin: raised

Question 23

Definitive management for Acute Cholangitis?

Answer 23

Laparoscopic Cholecystectomy (+/- ECRP clearance of CBD, sphincterotomy, stenting )

Question 24

Supportive management of Acute Cholangitis? ($)

Answer 24

1. Analgesia
2. Antiemetics
3. IV fluids
4. Antibiotics

Question 25

Investigations for Acute Cholangitis?

Answer 25

1. Bloods - FBC, CRP, LFTs | 2. Imaging - Abdo USS, MRCP