Gallstones and cholecystitis Flashcards
gallstones
may cause no Sx
occasionally discovered as incidental finding
epidemiology of gallstones
most common presentations:
biliary colic (56%) and acute cholecystitis (36%)
10-15% in the western world develop cholecystitis
cholecystitis
inflammation of the gallbladder
risk factors for gallstones
fair, fat, female, fertile, forty
also:
increasing age
FHx
sudden weight loss eg after obesity surgery
loss of bile salts eg after ileal resection, terminal illness
DM, as part of the metabolic syndrome
oral contraception (particularly in younger women)
types of stone
bile contains cholesterol, bile pigments and phospholipids
cholesterol stones: 80% of all in UK. large, often solitary and radiolucent
black pigment stones: small, friable (easily crumbled), irregular and radiolucent. risk factors include haemolysis
mixed stones are faceted and are comprised of calcium salts, pigment and cholesterol. 10% are radiopaque
brown pigment stones (<5% UK) form as a result of stasis and infection within the biliary system, usually in the presence of E. coli and Klebsiella spp.
presentation - gallstones
biliary colic most common
may also cause pancreatitis, obstructive jaundice
biliary colic
sudden RUQ/epigastric pain
may radiate around to the back in the interscapular region
often does not fluctuate, but persists anywhere from 15mins - 24h
subsides spontaneously or with analgesics
n&v often accompanies the pain
DDx
reflux peptic ulcers IBS relapsing pancreatitis tumours (stomach, pancreas, gallbladder)
investigations - gallstones
urinalysis, CXR and ECG may help rule others out
USS to demonstrate stones
LFTs
endoscopic retrograde cholangiopancreatography (ERCP) may be used for diagnosis, and also used for removal of stones
risk factors - cholecystitis
gallstones or biliary sludge (95% of patients) hospitalisation for trauma or acute biliary illness female increasing age obesity rapid weight loss pregnancy crohn's hyperlipidemia
presentation - cholecystitis
follows impaction of a stone on the cystic duct
may cause continuous epigastric or RUQ pain, vomiting, fever, local peritonism, GB mass
main difference to gallstones is the inflammatory component (local peritonism, fever, raised WCC)
if the stone moves to the CBD, jaundice may occur
murphy’s sign
murphy’s sign
lay 2 fingers over the RUQ
ask patient to breathe in
causes pain as the inflammed gallbladder is pressed down onto fingers
only positive if similar movement in LUQ does not cause pain
chronic cholecystitis
repeated attacks of acute cholecystitis lead to chronic
walls of GB become thickened and scarred
GB becomes shrivelled
investigations - cholecystitis
FBCs (raised WCC)
LFTs
USS - thickened GB wall (>3mm), maybe pericholecystic fluid or air in GB or GB wall
pancreatitis
passage of gallstone into the bowel can temporarily block the biliopancreatic duct
leads to premature release of enzymes
Sx: persistent epigastric pain radiates to the back relieved by sitting forwards profuse vomiting
