71. Gallstones (cholelithiasis) Flashcards Preview

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Flashcards in 71. Gallstones (cholelithiasis) Deck (25):
1

... all gallstones ( cholelithiasis)

high cholesterol an/or bilirubin , low bile salts or phospholipids (leithin ) and glabladder stasis

2

types - Mc

1. cholesterol stones (mc 80%)
2. pigmented stones

3

definition and types and radiolucent or radiopaque

cholelithiasisQ solide round stone in gallbladder
1. cholesterol stones --> raiolucent with 10-20% radiopaque due to calcifications
2. pigmented stones --> if black --> radiopaque ( Ca2+ bilirubinate, hemolysis), if brown (infection) --> radiolucent

4

cholelithiasis - cholesterol stones are associated with

1. estrogen (female, obesity, multiparity, estrogen therapy)
2. Crohn
3. advanced age
4. rapid weight loss
5. native american origin
6. fibrates

5

cholelithiasis - pigment stones are associated with

1. Crohn
2. chronic hemolysis
3. alcoholic cirrhosis
4. advanced age
5. biliary infections ( ascaris lumbricoides, clonarchis, sinensis)
6. total parental nutrition

6

cholelithiasis- diagnosis and treatment

diagnosis : US
treat with cholecystectomy if symptomatic

7

uncomplicated cholelithiasis - manifests as ( mechanism )

Biliary colic neurohormonal activation (eg. by CCk after a fatty meal) --> contraction of gallbladder, forcing a stone into the cystic duct --> waxing and wanning tight quadrant pain ( may be asymptomatic eg. diabedics)

8

cholelithiasis - complication (which is the MC)

1.cholecystitis (MC
2. aute pancreatitis
3. ascending cholangitis

9

symptoms of cholangitis

charcot triad
1. jaundice
2. fever (usually rigors)
3. RUG pain

10

• List the two types of gallstones.

Cholesterol stones and pigment stones

11

• A woman with a history of obesity, OCP use, and multiple pregnancies will likely have radiolucent or radiopaque kind of stones?

Radiolucent (the patient likely has cholesterol gallstones)

12

• Approximately what percentage of cholesterol stones are radiopaque?

10–20% (due to calcification)

13

• Why does Crohn disease predispose patients to gallstones?

Because of the inability of the diseased terminal ileum to absorb bile salts

14

• List at least four common risk factors for the formation of cholesterol stones.

Obesity, Crohn disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin

15

• What percentage of gallstones are cholesterol stones?

80%

16

• An alcoholic with a history of cirrhosis and biliary infections will most likely have what kind of gallstones (radiolucent or radiopaque)?

Radiopaque (the patient likely has pigment gallstones)

17

• A patient has RUQ pain, jaundice, and fever. Ultrasound shows gallstones, and labs show elevated white blood cells. What is the diagnosis?

Acute cholangitis (Charcot triad = RUQ pain, jaundice, and fever)

18

• List at least three common risk factors for pigment stones.

Chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infection, total parenteral nutrition

19

• A 39-year-old overweight woman presents with jaundice and RUQ pain. How would you diagnosis her condition, and what is the treatment?

Ultrasound to identify a distended gallbladder with stones; cholecystectomy

20

• Name at least two major complications of gallstones.

Ascending cholangitis, acute pancreatitis, bile stasis, cholecystitis

21

• Define biliary colic.

Biliary contraction pain after eating due to neurohormones (e.g., CCK) forcing a gallstone into the cystic duct, causing visceral irritation

22

• Ultrasound shows an 8-mm stone in the cystic duct of a long-time diabetic man. Despite this, he had no complaint of significant pain. Why?

Diabetic patients might have neuropathy, which can reduce the sensation of pain from gallstones

23

• What radiographic finding is associated with obstruction of the ileocecal valve by a gallstone?

Air in the biliary tract (also known as pneumobilia or gallstone ileus)

24

• Name the 4 Fs associated with an increased risk of developing gallstones.

Female, Fat, Fertile (prgenancy), Forty (age)

25

• A patient has jaundice, fever, and right upper quadrant pain. Likely diagnosis?

These symptoms are classic for the Charcot triad, which indicates cholangitis

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