Gallstone diseases

Question 1

What are some risk factors for gallstones

Answer 1

1) Metabolic syndrome factors (eg obesity, DM, NAFLD)
2) Dietary (high calorie, high carbohydrate, low fibre intake)
3) Gallbladder hypomotility (prolonged fasting, TPN, gastrectomy)
4) Increase in enterohepatic bilirubin cycling (cirrhosis, crohns)
5) Drugs (octreotide, fibrates)

Question 2

What blood test abnormalities will you see in pancreatitis, cholangitis, cholecystitis, choledocholithiasis

Answer 2

1) Pancreatitis (increase in lipase and amylase, lipase rises first)
2) Cholangitis (high ALP, GGT, bilirubin)
3) Cholecystitis (may have normal ALP and GGT if uncomplicated)
4) Choledocholithiasis (may have elevated ALT and AST first, followed by high ALP GGT)

Question 3

What are some analgesics that can be prescribed for biliary colic

Answer 3

NSAIDS

Question 4

Why is there dark urine in obstructive jaundice

Answer 4

Obstruction of bile flow (e.g., due to gallstones, tumors, or strictures) prevents bile (which contains conjugated bilirubin) from entering the intestines.

As a result, conjugated bilirubin backs up into the liver and then leaks into the bloodstream.

Unlike unconjugated bilirubin (which is fat-soluble), conjugated bilirubin is water-soluble, so it can be filtered by the kidneys and excreted in the urine.

Question 5

What are some appropriate tests for patients with jaundice

Answer 5

• FBC
• LFT
• Urea, creat, electrolytes
• bilirubin
• albumin
• PT/INR

Question 6

How do you tell alcoholic hepatitis in a LFT

Answer 6

AST and ALT will be elevated but rarely greater than 400. AST may be more than the ALT in ratio 2:1