Gallstones (inc. bile duct stones) Flashcards
What is the definition of gallstones/bile duct stones?
Hard crystallized mass formed abnormally in the gall bladder/bile ducts
How common are gallstones?
10-15% of adults in the Western world
What is the pathology of gallstones/bile stones?
- 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
What are the risk factors/aetiology of gallstones/bile stones?
- 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
What are the signs/symptoms of gallstones/bile stones?
- 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
What are diseases that present similarly to gallstones/bile stones?
- IBS
- Renal colic
- Carcinoma of the R side of the colon
- Atypical peptic ulcer disease
- Pancreatitis
- Intrahepatic abscess
- MI - rare
- Basal pneumonia - rare
What investigations are carried out for suspected gallstones/bile stones?
- 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
What are the surgical treatments for gallstones/bile stones?
- 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
What are the pharmacological treatments for gallstones/bile stones?
- Statins
- Analgesia
- Ursodeoxycholic acid – dissolves gallstones
- IV antibiotics
- Fluids
What are the non pharmacological treatments for gallstones/bile stones?
- Low cholesterol diet
- Avoiding trigger foods e.g. fatty, spicy foods
- NBM