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Hospital Based Medicine And Surgery > L21: Gallstones > Flashcards

L21: Gallstones Flashcards

1
Q

What is the calots triangle

A

A triangle that is bordered by the:

  • cystic duct
  • common Hepatic duct
  • right lobe of the liver
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2
Q

What is the significance of the calots triangle

A

When you perform a cholecystectomy the 2 principle structure you need to identify are:
Cystic duct and cystic artery

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3
Q

Where are gallstones produced

A

In the liver by the hepatocytes

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4
Q

Where is bile stored

A

In the gallbladder

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5
Q

What is the role of the gallbladder

A

Store bile and release bile when you have a meal

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6
Q

Which hormone from the gut is released during a meal that causes the release of bile

A

Cholesytakinin

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7
Q

What are the 3 types of gallstones

A

Cholesterol
Pigment
Mixed

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8
Q

What is the feature of cholesterol gallstone

A

Heard and yellow

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9
Q

What is the feature of pigmented gallstone

A

Black and crumbly

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10
Q

What is the presentation of gallstones

A

Biliary colic

Acute cholecystitis

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11
Q

What is a biliary colic

A

Pain upon the gallbladder contraction after a meal

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12
Q

What is a acute cholecystitis

A

Chemical inflammation of the gallbladder obstruction

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13
Q

How does a bilary colic present

A

Right upper quadrant pain
Radiates to the back or shoulder
Occurs after a meal
Can have nausea and vomiting

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14
Q

On examination what would be the findings in a biliary colic

A

Right upper quadrant tenderness

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15
Q

On a blood sample what would be the findings in a biliary colic

A

Normla

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16
Q

What is the presentation of acute cholecystitis

A 
Epigastric, right upper quadrant pain
Radiation to the back and shoulder
Constant pain
Worse on movement 
Nausea and vomiting
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17
Q

On examination what are the findings of acute cholecystitis

A

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

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18
Q

On a blood test what would be the findings to acute cholecystitis

A

High white cell blood count
High CRP
Icreased LFTs
Ultrasound gallstones with thick wall of gallbladder

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19
Q

What is the treatment of biliary colic

A

Conservative

Surgery

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20
Q

What is the treatment of acute cholecystitis

A

Oxygen, fluid and analgesia
Antibiotics
Surgery
Drainage

21
Q

What is acalculous cholecystitis

A

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

22
Q

What is the presentation of acalculous cholecystitis

A

Patient is unwell
Post op patient
Right upper quadrant tenderness
Vomiting

23
Q

On a ultrasound what will acalculous cholecystitis show

A

Dilated thick gallbladder wall but no gallstones

24
Q

What is the treatment of acalculous cholecystitis

A

Antibiotics
Drainage
Surgery

25
Q

What are common bile duct stones

A

When the gallstones are outside the gallbladder and into the common bile duct

26
Q

What are the causes of common bile duct stones

A

Primary: stone has formed in the common bile duct

Secondary; stone has formed in the gallbladder and passed into the common bile duct

27
Q

What is the presentation of common bile duct stone

A

Obstructive jaundice
Acute pancreatitis
Acute cholangitis

28
Q

What is obstructive jaundice

A

When the common bile duct stone impacts the ampulla and obstructs the free flow of bile into the duodenum

29
Q

What are the features of obstructive jaundice

A

Darker urine
Pale stools
Pain

30
Q

What investigations can be done for obstructive jaundice

A

Increased LFTs; increased bilirubin, increase alp
Ultrasound: common bile duct dilatation and stones
MRCP: detailed bilary anatomy

31
Q

What is the treatment for obstructive jaundice

A

Elevate the obstruction by ERCP spinchterotomy

32
Q

What can obstructed jaundice develop into

A

Acute cholangitis

33
Q

What is acute cholangitis

A

When you have the obstruction and you get secondary bacterial infection on top of it

34
Q

What is the presentation of acute cholangitis

A

Charcots triad: right upper quadrant pain, jaundice, rigours (involuntary shaking)
Mild confusion
Septic shock

35
Q

What is the treatment of acute cholangitis

A

Iv fluids, oxygen, analgesia
Antibiotic
ERCP: removal and stent
Surgery

36
Q

What is a gallstone ileus due to

A

Cholecystoduoenal fistula (fistual betwwen they duodenum and gallbladder)

37
Q

What is the presentation of gallstone ileus

A

Pain
Vomiting
Constipation
Abdominal distension

38
Q

What is the investigation for gallstone ileus

A

AXR: will show small bowel obstruction
Ct: will show small bowel obstruction

39
Q

What is the treatment of gallstone ileus

A

Resuscitation with iv fluid and oxygen
Ng
Surgery

40
Q

What are gallstones known as

A

Cholethiasis

41
Q

What are gallstones in the gallbladder known as

A

Biliary colic

42
Q

What are gallstones in the gallbladder or cystic duct known as

A

Bilary colic

43
Q

What is gallstones in the gallbladder/cystic duct that is inflammed known as

A

Acute Cholecystitis

44
Q

What is a gallstone in the common duct that has become inflammed known as

A

Acute cholangitis

45
Q

What is the triad known for acute cholangitis

A

Charcots triad: jaundice, fever, right upper quadrant pain

46
Q

When does the murphys sign become present

A

Acute cholecystitis

47
Q

What is acalculous cholecystitis

A

Cholecystitis in the absence of gallstones

48
Q

What are the features of obstructive jaundice

A

Pale stool

Darker urine

Hospital Based Medicine And Surgery (30 decks)

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