0306 - Gallstones and Their Complications Flashcards
What are some differentials for gallstones?
Biliary colic
Acute cholecystitis
Pancreatitis
Gastroenteritis
What are the F’s for gallstones?
Female Fertile Fat Forty Fair
What is the epidemiology of gallstones
25% of population, 8% symptomatic
Progresses at 1%/year
Describe the most common gallstones (composition, type etc)
80-90% of stones cholesterol-based
Pure cholesterol - yellow-white and large
Mixed most common - small, multiple, and may have black core of unconjugated bilirubin.
What are the three conditions for cholesterol stone formation?
Cholesterol super-saturation
Accelerated nucleation
Gallbladder hypomotility
Describe pigment gallstones
10-25% of all stones
More common in Asians
Dark pigment from bilirubin precipitation (unconjugated)
Complication of haemolytic anaemia.
Describe biliary colic
Spasm of Gallbladder due to stone stuck in neck
30% have no further pain over 24 months, but nearly 100% get further symptoms within 5 years
Risk of serious complications (surgery) 1-2%/year.
What is the clinical presentation of cholangitis?
Obstructive Jaundice (yellow skin, pale stool, dark urine), epigastric pain, fever
High risk of Sepsis - need IV ABx and urgent drainage
ERCP, sphincterotomy and stone extraction.
Describe gallstone pancreatitis
Stone at common channel of common bile duct and pancreatic duct (Ampulla of Vater)
Elevated GGT, ALP, Bilirubin, AST
Elevated pancreatic enzymes >3x normal (lipase more reliable than amylase)
What are the typical investigations for suspected gallstones?
UEC - Should be normal
LFT - should be normal, but may have raised ALP and GGT.
Lipase if suspect pancreatitis
Coagulation studies if have liver disease
Imaging - ULTRASOUND!
What is ERCP?
Endoscopic Retrograde CholangioPancreatography
What are the most common complications of gallstones?
Intermittent Biliary colic (20%)
Impacted in cystic duct - acute cholecystitis (10%)
Impact in distal common bile duct causing gallstone pancreatitis (5%)
