Gastro - Cholelithiasis

Question 1

Cholelithiasis definition?

Answer 1

Gallstones are small stones that form in the gallbladder and are formed from concentrated bile. Most stones are made of cholesterol

Question 2

Extra definitions?

Answer 2

Cholestasis – blockage of bile flow
Choledocholithiasis – gallstone in bile duct
Biliary colic – intermittent RUQ pain caused by gallstones irritating bile duct
Cholecystitis – inflammation of gallbladder
Cholangitis – inflammation of bile duct
Gall bladder empyema – pus in gallbladder
Cholecystectomy – removal of gallbladder
Cholecystostomy – inserting drain into gallbladder

Question 3

Explain the basic anatomy of the gallbladder and the bile duct?

Answer 3

Left and right hepatic ducts join into common hepatic duct before the gallbladder. The gallbladder has the cystic duct which comes and joins common hepatic duct into the common bile duct.
Common bile duct means the pancreatic duct at a point known as the ampulla of vater where bile is released into the duodenum.

Sphincter of Oddi is a ring of muscle that controls the flow of bile and pancreatic secretions at the ampulla of vater

Question 4

Cholelithiasis Causes?

Answer 4

Family hx
Age
Female
Abnormal eating (obesity, rapid weight loss, prolonged fasting)

High fibre diet, nut consumptions

Question 5

What are the risk factors of Cholelithiasis?

Answer 5

Four Fs

Fat
Fair
Female
Forty

Question 6

Cholelithiasis Sx?

Answer 6

Can be asympto
Main Sx is biliary colic (pain from temporary obstruction and pain is relieved when gallstone falls back) – epigastric or RUQ pain triggered by meals especially those that are high fat. Lasts between 30mins and 8hrs

Fever

Question 7

Why does fat cause biliary colic?

Answer 7

Fat entering digestive system causes cholecystokinin release which contracts gall bladder causing biliary colic.
Fat is avoided in patients with gallstones to stop CCK release

Question 8

Cholelithiasis Dx?

Answer 8

Murphy’s sign

LFT:
raised bilirubin, pale stool, dark urine; these 3 indicated obstruction in system. Tho this can be tumour of head or pancreas or cholangiocarcinoma.
Increase alkaline phosphatase.
Raised ALT and AST (higher ALP rise)

Xray (10% of gallstones are calcified)
US
Magnetic resonance cholangio-pancreatography
Endoscopic retrograde cholangiopancreatography

Question 9

Cholelithiasis complications?

Answer 9

Acute cholecystitis
Cholangitis
Obstructive jaundice
Pancreatitis
Gall bladder empyema
Obstructive jaundice
Perforation -> peritonitis
Post cholecystectomy syndrome

Question 10

Cholelithiasis Tx?

Answer 10

Cholecystectomy:
Emergency cholecystectomy indicated if: stone >2cm, nonfunctional gallbladder, pt with spinal cord injury, pt with sickle cell anemia (distinction between sx is difficult).

Medical tx:
oral bile salt therapy
extracorporeal shockwave lithotripsy

Lifestyle:
Exercises and low-fat healthy diet

Question 11

What is murphy’s sign?

Answer 11

Deep inspiration exacerbates pain during palpation of RUQ, involuntary guarding

Question 12

What is post cholecystectomy syndrome?

Answer 12

Group of nonspecific sx after operation.
diarrhoea
Indigestion
Epigastric or RUQ pain
Nausea
Intolerance to fatty foods