Surgical Management of the Gallbladder Flashcards
1
Q
What is the cause of gallstones?
What are the risk factors?
A
- Derangement of biliary chemistry.
- Female sex.
- Getting older.
- Being fertile or on the oral contraceptive pill.
- Family history.
- Obesity
2
Q
How do gallstones present?
A
- Many are asymptomatic - most people do not get abnormal LFTs.
- Biliary colic
- Biliary dyspepsia
- Acute cholecystitis
- CBD stones / jaundice
- Acute pancreatitis
- Gallstone ileus - presents with small bowel obstruction
3
Q
What is gallstone ileus?
A
A gall stone becomes lodged in the small bowel.
4
Q
Describe cholecystitis.
A
- A stone becomes trapped in the cystic duct.
- Bile cannot be ejected from the gallbladder and it stagnates.
- The stagnated bile irritates the gallbladder mucosa which (in response) secretes mucous and inflammatory enzymes.
- This results in distension and pressure build-up in the gall bladder.
- This is cholecystitis.
5
Q
What are the characteristics of biliary colic?
A
- Severe pain in RUQ / epigastrium.
- Lasting minutes or hours.
- May radiate to the back or chest (? IHD).
- Often nausea or vomiting.
- Usually settles spontaneously.
- Recurrence may be associated with fat intake.
- If patients eat less fat they get fewer episodes of biliary colic and are systemically okay.
- Minimal systemic upset.
6
Q
What are the symptoms and signs of acute cholecystitis?
A
- ? History of biliary colic.
- More presistent pain.
- RUQ tenderness (? Murphy’s sign).
- May have systemic pointers (↑ T, ↑ WBC, ↑ CRP).
- More unwell, likely to be admitted.
7
Q
How should biliary colic be managed?
A
- Analgesia
- Low fat diet
- Elective surgery if patient is seriously troubled
- ?Stone dissolution
8
Q
How should acute cholecystitis be managed?
A
- IV fluids
- Antibiotics
- Analgesia
- Urgent investigation
- Surgery if fit and common bile duct is clear
9
Q
Which investigations should be carried out on a patient who has ? acute cholecystitis?
A
- LFTs, amylase (anyone with upper abdominal pain should have acute pancreatitis excluded).
- USS scan.
- ? MRCP (magnetic resonance cholangiopancreatography).
- General fitness.
10
Q
How are common bile duct stones are managed?
A
- ERCP (Endoscopic retrograde cholangiopancreatography) for most.
- At operation (laparoscopic or open).
11
Q
What are the complications of ERCP?
A
- Acute pancreatitis
- Bleeding
- Perforation
12
Q
What are the symptoms of obstructive jaundice?
A
- Jaundice; itching
- Painful or painless
- Dark urine
- Pale stools
- ? Fever
13
Q
What are the causes of obstructive jaundice?
A
- CBD stones
- Benign biliary stricture
- Intrahepatic / PBC
- Malignancy
14
Q
How should obstructive jaundice be managed?
A
- Blood tests including liver screen.
- Imaging USS, usually followed by CT and/or MRCP.
- ERCP +/- stent, or stone removal.
- Endoscopic US +/- biopsy.
15
Q
What is Charcot’s triad?
A
- RUQ pain and tenderness
- Obstructive jaundice
- Fever +/- rigors
