GB stones

Question 1

Q2. What’s the most probable diagnosis?

Answer 1

Cholelithiasis (Gallstones)

Question 2

Stem: young patient with RUQ pain and epigastric pain aggravated by fatty meals. His news score is 0

Q1. What’s your differential diagnosis?

Answer 2

Surgical – Cholecystitis, Pancreatits, Appendicitis, perforated PU, Choledolethiasis
Some medical causes; MI, Myositis, Pleurisy

Question 3

Q3. What are the risk factors for gallstones?

Answer 3

Pigmented; More common in Asian, Hx of hemolytic anemia, Crohn’s Dis, Infection to biliary syst.
Cholesterol; More common in Western pop. And females , OCP, Old age, Obesity, hyperlipidemic dis, rapid loss of wt

Question 4

Q4. What are the types? What is the pathophysiology of gallstones?

Answer 4

Cholesterol; formed by supersaturation of bile pig. With cholestearol (exceeds capcity of bile pig.) formations of cholesterol crystals and hypersection of mucus in GB
Pigmented; Elevation of unconj. Bilirubin Due to Chr. Hemolytic Anemia. / Bact. Contamination of biliary tree / sever ileal dysfunction.

Question 5

Q5. In this young patient with no fever, what investigations would you request?

Answer 5

LFT/ US / MRCP (according to the previous US (dilated CBD without stone/ elevated LFT)

Question 6

Q6. How would you manage gallbladder stones?

Answer 6

Asymp; Reassure.
Sympt; Elective Lap Chole
Acute Cholecystitis; Fluids, Abx, Painkillers and then early Lap cholecystectomy within 1 wk
– Percutaneous cholecystostomy Draine in case of unfit for surgery/ Failed conserve

Question 7

Q7. If there is CBD stones, what would be your management?

Answer 7

Bile duct clearance Lap Chole in both Symp and asymp
Clearance by ERCP / surgical at time of lap
Use biliary stent if failed to clear bile duct to make temp biliary drainage

Question 8

Q8. What is MRCP? What is its indications?

Answer 8

Magnetic Resonance cholangiopancreaticography
used to produce detailed images of heptobiliary tree and pancreatic syst.
Indication;
– Id cong. Anomalies of cyst and hepatic ducts
– post-surgical complications and anatomy
– Strictures
–pancreatic cyst lesion
– CI for ERCP like acute pancreatitis or anomaly to PBtree like pancrease divisum

Question 9

Q9. If the patient has a fever, what could be the diagnosis?

Answer 9

Acute chole / Ascending cholangitis / Empyema

Question 10

Q10. What surgery will you do for acute cholecystitis?

Answer 10

Lap chole early

Question 11

Q11. If patient is not fit for surgery, what will you do?

Answer 11

Percutaneous cholecystostomy

Question 12

Q12. What the risks or possible complications of laparoscopic cholecystectomy?

Answer 12

Anathetic complications / Bleeding/ DVT / Injury to CBD / Bile leakage / peritonitits / Strictures and fibrosis / Post Chole syndrome / Missed stone /jaundice / Wound complications

Question 13

Q13. What are the complications of gallstones?

Answer 13

Biliary colic / Acute – Chronic Chole / Obstruction / Acute pancreatitis / Empymea / Intest. Obst. By fistula / Mucocele / Perforation /

Question 14

Q14. If gallbladder is infected, what would be your management?

Answer 14

Cholecystectomy

Question 15

Q15. If the patient is a frail 90 years old lady, what would be your management?

Answer 15

IV Fluids / Abx / Analgesia / Use medics ursodiol chenodiol