Gallstone disease

Question 1

How do gallstones form?

Answer 1

Solids settling from a solution

Question 2

Name the contents of bile solutions

Answer 2

Bilirubin
Bile pigments
Phospholipids
Cholesterol

Question 3

Classify gallstones according to their contents

Answer 3

1. Cholesterol
2. Mixed
3. Pigment

Question 4

What type are the majority of gallstones?

Answer 4

Cholesterol

Question 5

Explain the 3 phases of cholesterol stone formation

Answer 5

1. Supersaturation
2. Nucleation of cholesterol crystals
3. Stone growth

Question 6

What is the dark colour in pigment stones due to?

Answer 6

Contain calcium bilirubinate

Question 7

Give characteristics of black stones

Answer 7

Small, brittle, spiculated
Assoc w/ haemolysis
Form in the gallbladder

Question 8

Give characteristics of brown stones

Answer 8

Usually <1cm
Soft and mushy
Assoc w/ bacterial infection
Primarily form in the bile ducts

Question 9

Which bacteria are linked to brown stones?

Answer 9

Bacteria that secrete beta-glucuronidase -> UB that precipitate with calcium and dead bacterial cells

Question 10

What is biliary sludge?

Answer 10

Mixture of cholesterol crystals, calcium bilirubinate and mucin-gel matrix

Question 11

What condition is biliary sludge associated with?

Answer 11

Fasting

Question 12

Name complications of gallstone disease

Answer 12

Gallbladder

• acute/chronic cholecystitis
• abscess
• hydrops
• Mirizzi syndrome
• Bouverette syndrome
• cancer

Biliary
- choledocholithiasis

Pancreatic
- acute pancreatitis

Question 13

Discuss the management of cholangitis according to the Tokyo guidelines

Answer 13

Mid 
- antibiotics
- biliary drainage
Moderate
- fluid resus
- antibiotics
- urgent drainage <48h 
Severe
- fluid resus
- organ support
- antibiotics
- emergency drainage <24h

Question 14

Which criteria are necessary for diagnosis of moderate acute cholangitis?

Answer 14

1. WCC (<4, >12)
2. Temperature >38
3. Age>75yo
4. Bilirubin >50
5. Albumin <73% lower limit of normal

Question 15

Name clinical features of acute cholecystitis

Answer 15

Murphy’s sign

Systemic inflammation

Question 16

Which criteria are necessary for diagnosis of moderate acute cholecystitis?

Answer 16

WBC >18
Palpable RUQ mass
Duration >72h
Marked local inflammation

Question 17

Discuss the management of acute cholecystitis

Answer 17

Antibiotics

Cholecystectomy