(!) Gallstones and billiary cholic

Question 1

Define Gallstones

Answer 1

Gallstones (Cholethialsis) are solid concretion in the gallbladder-form in there but can be pushed out and block conduits
most are made from cholesterol

can be asymptomatic, or symptomatic as it blocks bile ducts
can be a risk/cause for numerous other disease

Question 2

Aetiology and risk factors of Gallstones

Answer 2

90% are cholesterol
can be genetic (and has a genetic component-female, age)
and modifiable causes- obesity, enteral nutrition, medication (oestrogen pill)
Other gallstones can be black-calcium billirubinate-from diseases causing high bilirubin (heam aneamoa)
Or brown-new after an episode of sepsis or stasis

happens when liver secretes too much cholesterol in bile. Or when bile is not excreted
can obstruct billiary tree,o ampulla-pancreatitis as pressure builds

Risk factors
Female
Age
Obesity
FHx gallstones
Liver disease
Medication
Hispanic origin

Question 3

Epidiemology of Gallstones

Answer 3

10-15% of all adults in US/Europe-very common
Females>men
asymtomatic in 80% of people
once billiary pain/colic develops (1% per year)-50% get recurrent pain and 3% complications

Question 4

Signs and Sx of Gallstones

Answer 4

80% are asymptomatic

1% per year develop to have billiary colic-constant dull pain increasing in intensity over few hours. responds to analgesia. After a meal

Murphy’s sign-RUQ tenderness on palpation (can’t palpate gallbladder)

jaundice (obstructive-itchy, dark urine)
nausea and jaudice would indicate complication (cholecystitis, etc)

Question 5

Investigations of Gallstones

Answer 5

Abdo USS-see the gallstones
and can see if stones are obstructing the bile ducts-

LFT’s-normal if asymptote
If obstruction (cholecondthialsis)-high ALP, normal ALT/AST, high bilirubin
Transiant obstruct-transient high ALT, normal ALP
Conjugated bilirubin

FBC-normal if no acute complication (cholecystitis, chlangitis)
Amylase-high if pancreatitis

MCRP

Question 6

Management of Gallstones

Answer 6

Asymptomatic-can offer elective cholecystomy

Biliary colic-analgesia (NSAIDS-diclofenac)

if Sx Gallstones-> laproscopic cholecystomy (shorter hospital stay)

ERCP to clear obstructions

diet modification

keep eye on complications-fever, jaundice, nausea

Question 7

complications of Gallstones

Answer 7

Can lead to bacterial growth in Gallbladder (cholecystitis) or in biliary tree (cholangitis)-> septic shock, liver damage
can block ampulla-acute pancreatitis

Treatment-ECRP can cause pancreatitis
can damage billiary tree
or bleeds

Question 8

Prognosis of gallstones

Answer 8

Great-especially if treated with surgery or ERCP-go away

reccurent are common if gallstone left there, duct dilation >15mm, brown pigment stones