25. Gallstones And Jaundice

Question 1

What is cholecystitis?

Answer 1

Inflammation of gallbladder

Question 2

What is choledocholithiasis?

Answer 2

Stone within bile ducts

Question 3

What is ascending cholangitis?

Answer 3

Inflammation of bile duct

Question 4

What are gallstones?

Answer 4

Stones in the gallbladder

Question 5

What is biliary colic?

Answer 5

Symptom of intermittent severe epigastric pain a/w stones in bile duct

Question 6

What is the aetiology of gallstones?
(7)

• 10% of adult population affected (F>M = 2:1) *

Answer 6

1. Gender
2. Obesity (bile supersaturated with cholesterol)
3. Haemolytic disorders
4. Diet (higher in Western world)
5. Meds (Clofibrate)
6. Age
7. Fertility

Question 7

What can gallstones cause IN the gallbladder?

5

Answer 7

1. Acute Cholecystitis
2. Post acute cholecystitis —> mucocoele, empyema, gangrene, perforation
3. Chronic Cholecystitis
4. Mirizzi’s Syndrome: stone in Hartmann’s pouch causing obstructive jaundice
5. Gallbladder Carcinoma —> porcelain gallbladder

Question 8

What do gallstones cause IN the CYSTIC DUCT? (Biliary colic)
(5)

Answer 8

1. Intense pain (RUQ or epigastric)
2. Distinct attacks
3. Intense
4. Usually within hours of eating meal
5. Few abdo signs

Question 9

What do gallstones cause OUTSIDE the gallbladder? (Gallstone Illeus)
(2)

Answer 9

• Least common and in elderly women
  1. Fistula between gallbladder and duodenum
  2. Presents as sub-acute small bowel obstruction

Question 10

What is the management and treatment of acute cholecystitis?
(6)

Answer 10

1. Analgesia
2. Abdo U/S
3. IV antibiotics —> initially a chemical sterile inflammation
4. IV fluids
5. Nil Po (if vomiting)
6. Laparoscopic Cholecystectomy

Question 11

What is the management and treatment of biliary colic?

4

Answer 11

1. Analgesia
2. IV fluids
3. Abdo U/S
4. Laparoscopic Cholecystectomy

Question 12

What is the management and treatment of stones in CBD?

4

Answer 12

1. U/S
2. MRCP (more reliable)
3. Requires urgent ERCP and sphincterotomy
4. Laparoscopic Cholecystectomy

Question 13

What is the management and treatment of ascending cholangitis?
(4)

Answer 13

1. Charcot’s Triad
2. IV antibiotics broad-spectrum (E.coli, Klebsiella, Streptococcus faecalis)
3. IV fluids
4. Emergency decompression of biliary system with ERCP

Question 14

What is the management and treatment of acute pancreatitis?
(3)

Answer 14

1. Urgent ERCP
2. Sphincterotomy
3. Laparoscopic Cholecystectomy

Question 15

What is a laparoscopic cholecystectomy?

Answer 15

Gallbladder removal through 5-8in long incision or cut in abdo

Question 16

What do you look for when taking a HISTORY in a gallstone exam?
(5)

Answer 16

1. Site and nature of pain
2. Associated symptoms
3. Jaundice
4. Rigours
5. Pale stools, dark urine, pruritis

Question 17

What do you look for when performing a PHYSICAL EXAM on a gallstone patient?
(5)

Answer 17

1. Jaundice
2. Pyrexial
3. Scratch marks
4. Murphy’s sign
5. Pancreatitis

Question 18

What lab studies do you perform on a gallstone patient?

4

Answer 18

1. FBC —> WCC
2. CRP
3. LFTs —> Billi, ALP, AST/ALT
4. Amylase

Question 19

What is surgical jaundice?

Answer 19

Jaundice due to intra- or extra-hepatic organic obstruction to biliary outflow

Question 20

What is biliary obstruction?

Answer 20

Blockage of any duct that carries bile from liver to gallbladder or from gallbladder to SI

Question 21

What is the comment form of obstruction and the commonest cause?

Answer 21

Extraphepatic

Gallstones

Question 22

What are other causes of jaundice?

6

Answer 22

1. Malignancy
2. Inflammation (pancreatitis)
3. Merizzi’s Syndrome
4. Parasites
5. Primary Sclerosing Cholangitis (PSC)
6. AIDS-related cholangiopathy