L21: Gallstones Flashcards
What is the calots triangle
A triangle that is bordered by the:
- cystic duct
- common Hepatic duct
- right lobe of the liver
What is the significance of the calots triangle
When you perform a cholecystectomy the 2 principle structure you need to identify are:
Cystic duct and cystic artery
Where are gallstones produced
In the liver by the hepatocytes
Where is bile stored
In the gallbladder
What is the role of the gallbladder
Store bile and release bile when you have a meal
Which hormone from the gut is released during a meal that causes the release of bile
Cholesytakinin
What are the 3 types of gallstones
Cholesterol
Pigment
Mixed
What is the feature of cholesterol gallstone
Heard and yellow
What is the feature of pigmented gallstone
Black and crumbly
What is the presentation of gallstones
Biliary colic
Acute cholecystitis
What is a biliary colic
Pain upon the gallbladder contraction after a meal
What is a acute cholecystitis
Chemical inflammation of the gallbladder obstruction
How does a bilary colic present
Right upper quadrant pain
Radiates to the back or shoulder
Occurs after a meal
Can have nausea and vomiting
On examination what would be the findings in a biliary colic
Right upper quadrant tenderness
On a blood sample what would be the findings in a biliary colic
Normla
What is the presentation of acute cholecystitis
Epigastric, right upper quadrant pain Radiation to the back and shoulder Constant pain Worse on movement Nausea and vomiting
On examination what are the findings of acute cholecystitis
Patient looks unwell
Increased hr
Right upper quadrant tenderness
Murphy sign- ask the patient is take a deep breath and and the diaphragm pushes down to the lover and gallbladder to cause more pain
On a blood test what would be the findings to acute cholecystitis
High white cell blood count
High CRP
Icreased LFTs
Ultrasound gallstones with thick wall of gallbladder
What is the treatment of biliary colic
Conservative
Surgery
What is the treatment of acute cholecystitis
Oxygen, fluid and analgesia
Antibiotics
Surgery
Drainage
What is acalculous cholecystitis
Acute cholecystitis in the absence of gallstones and it is due to micro vascular ishcaemia in the gallbladder wall which can progress to a gangrene
What is the presentation of acalculous cholecystitis
Patient is unwell
Post op patient
Right upper quadrant tenderness
Vomiting
On a ultrasound what will acalculous cholecystitis show
Dilated thick gallbladder wall but no gallstones
What is the treatment of acalculous cholecystitis
Antibiotics
Drainage
Surgery
What are common bile duct stones
When the gallstones are outside the gallbladder and into the common bile duct
What are the causes of common bile duct stones
Primary: stone has formed in the common bile duct
Secondary; stone has formed in the gallbladder and passed into the common bile duct
What is the presentation of common bile duct stone
Obstructive jaundice
Acute pancreatitis
Acute cholangitis
What is obstructive jaundice
When the common bile duct stone impacts the ampulla and obstructs the free flow of bile into the duodenum
What are the features of obstructive jaundice
Darker urine
Pale stools
Pain
What investigations can be done for obstructive jaundice
Increased LFTs; increased bilirubin, increase alp
Ultrasound: common bile duct dilatation and stones
MRCP: detailed bilary anatomy
What is the treatment for obstructive jaundice
Elevate the obstruction by ERCP spinchterotomy
What can obstructed jaundice develop into
Acute cholangitis
What is acute cholangitis
When you have the obstruction and you get secondary bacterial infection on top of it
What is the presentation of acute cholangitis
Charcots triad: right upper quadrant pain, jaundice, rigours (involuntary shaking)
Mild confusion
Septic shock
What is the treatment of acute cholangitis
Iv fluids, oxygen, analgesia
Antibiotic
ERCP: removal and stent
Surgery
What is a gallstone ileus due to
Cholecystoduoenal fistula (fistual betwwen they duodenum and gallbladder)
What is the presentation of gallstone ileus
Pain
Vomiting
Constipation
Abdominal distension
What is the investigation for gallstone ileus
AXR: will show small bowel obstruction
Ct: will show small bowel obstruction
What is the treatment of gallstone ileus
Resuscitation with iv fluid and oxygen
Ng
Surgery
What are gallstones known as
Cholethiasis
What are gallstones in the gallbladder known as
Biliary colic
What are gallstones in the gallbladder or cystic duct known as
Bilary colic
What is gallstones in the gallbladder/cystic duct that is inflammed known as
Acute Cholecystitis
What is a gallstone in the common duct that has become inflammed known as
Acute cholangitis
What is the triad known for acute cholangitis
Charcots triad: jaundice, fever, right upper quadrant pain
When does the murphys sign become present
Acute cholecystitis
What is acalculous cholecystitis
Cholecystitis in the absence of gallstones
What are the features of obstructive jaundice
Pale stool
Darker urine
