Gallstones (inc. bile duct stones) Flashcards

1
Q

What is the definition of gallstones/bile duct stones?

A

Hard crystallized mass formed abnormally in the gall bladder/bile ducts

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2
Q

How common are gallstones?

A

10-15% of adults in the Western world

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3
Q

What is the pathology of gallstones/bile stones?

A
  • 2 type of gallstone: cholesterol and pigment/bilirubin stones (Ca, Cu)
  • High fat foods cause the secretion of bile into the intestine = emulsification
  • Supersaturation of cholesterol means the bile salts can no longer keep cholesterol dissolved = precipitate out
  • Not enough salts/acids = precipitation
  • Gallbladder stasis = precipitation (like oil in a PB jar)
  • Too much bilirubin that combines with Ca = precipitate
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4
Q

What are the risk factors/aetiology of gallstones/bile stones?

A
  • Age (less common in under 30’s)
  • Gender – 2/3 times more common in woman
  • Race – more common in Scandinavians, south Americans and native north Americans
  • Obesity
  • Metabolic syndromes
  • Rapid weight loss
  • Diabetes
  • High cholesterol diet
  • High oestrogen levels – pill, pregnant, HRT
  • Cirrhosis, primary sclerosing cholangitis, Crohn’s disease, IBS
  • Cefriaxone
  • Acromegaly treated with octreotide
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5
Q

What are the signs/symptoms of gallstones/bile stones?

A
  • Majority asymptomatic
  • Sudden constant dull epigastric/right hypercondrium pain – may radiate to right flank/scapula, can be triggered by fatty foods
  • Murphy’s sign – pain at right subcostal margin due to gallbladder/liver inflammation
  • Nausea/vomiting
  • Indigestion
  • Bloating/burping
  • Pain = biliary colic
  • Pain + temp = cholecystitis
  • Pain + temp + jaundice = cholangitis
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6
Q

What are diseases that present similarly to gallstones/bile stones?

A
  • IBS
  • Renal colic
  • Carcinoma of the R side of the colon
  • Atypical peptic ulcer disease
  • Pancreatitis
  • Intrahepatic abscess
  • MI - rare
  • Basal pneumonia - rare
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7
Q

What investigations are carried out for suspected gallstones/bile stones?

A
  • Bloods – FBC (leucocytes slightly ↑), LFT’s, amylase/lipase (pancreatic complications)
  • Serum bilirubin ↑
  • Alkaline phosphatase ↑
  • Aminotransferase ↑
  • Abdominal US
  • MRI – gallstones in the bile ducts
  • Cholangiography – contrast xray to find a blockage
  • Biliary scintigraphy – to find duct obstruction
  • CT – if any complications e.g. acute pancreatitis
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8
Q

What are the surgical treatments for gallstones/bile stones?

A
  • Laproscopic cholecystectomy
  • Open cholecystectomy – 3rd trimester of pregnancy, extremely overweight, unusual anatomy that makes keyhole difficult
  • Endoscopic retrograde cholangio-pancreatography (ERCP)
  • Stone dissolution and shock wave lithotripsy
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9
Q

What are the pharmacological treatments for gallstones/bile stones?

A
  • Statins
  • Analgesia
  • Ursodeoxycholic acid – dissolves gallstones
  • IV antibiotics
  • Fluids
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10
Q

What are the non pharmacological treatments for gallstones/bile stones?

A
  • Low cholesterol diet
  • Avoiding trigger foods e.g. fatty, spicy foods
  • NBM
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