Gallstones Flashcards
(28 cards)
Biliary colic is also known as what
Cholelithiasis
What is biliary colic AKA cholelithiasis?
Stone irritating gallbladder or stuck in cystic duct or ampulla of Vater
Biliary colic
- Where is the pain
- Where does it radiate
- What triggers it
- What associated S+S
- How long lasts
- Makes you want to stay still or move around
RUQ pain radiates to back Triggered by eating (fatty foods) Associated N+V Lasts hours (subsides spontaneously) -Makes you want to move (visceral pain)
FBC, CRP and LFTs may all be normal in biliary colic, true or false
True
What is the 1st line investigation for biliary colicWh?
US
(measure gallbladder wall thickness
Gallstones are normally radiolucent or radiopaque?
What colour is that - black of white?
Radiolucent black
What is the Mx of biliary colic?
Elective laparoscopic cholecystectomy
Lap chole complications
- 5% get what
- 1 in 250 get what
5% chronic diarrhea
1 in 250 bile duct damage
What is acute cholecystitis?
Stone stuck in neck of gallbladder causing inflammation +- ischaemia
(Risk progressing to necrosis if untreated)
Acute cholecystitis pain
- where
- radiates where
- severe or mild
- associated symptoms
- lasts how long
- want to stay still or move around
RUQ radiates shoulder tip/back severe assoc fever, N+V, tender lasts longer than biliary colic want to stay still (peritonism)
What is Murphy’s sign? what is it seen in? is it a reliable sign?
Lay 2 fingers over RUQ; pain when PTx inspires as inflamed GB touches examiner’s hand
In acute cholecystitis
Highly specific
What is the Mx of acute cholecystitis?
IV/PO ABx
LAP chole within 1wk of S+S onset
A gallbladder empyema is a complication of acute cholecystitis, what is the Mx of this?
Percutaneous cholecystostomy
What investigation is done for complications of acute cholecystitis?
CT
eg pancreatitis, gallbladder perforation, gallbladder empyema
What is ascending cholangitis?
Bile duct infection secondary to gallstone blocking biliary flow
What is Charcot’s triad?
RUQ pain + fever + obstructive jaundice
In ascending cholangitis
What are the 4 Fs for gallstones?
Female
Fat
Fair
Fourty
Statorrhea and bilirubinuria can be seen in ascending cholangitis - T or F
True
How is ascending cholangitis diagnosed?
US poor at identifying stones in CBD
ERCP
What is the management of ascending cholangitis?
IV ABx
Clear bile duct by lap chole or ERCP
What is the management of incidentally found gallstones?
Doesn’t require intervention unless symptomatic
majority of gallstones don’t ever cause symptoms
What investigation should be done for patients with upper abdo pain to exclude air under the diaphragm?
Erect CXR
What management of gallstones is offered for frail elderly patients unfit for cholecystectomy? (i.e. can’t handle GA)
Percutaneous cholecystostomy
(inserted by an interventional radiologist)
(drains bile to skin)
(also given to patient with severely inflamed gallbladder while waiting for information to settle whilst awaiting surgery)
At how many mm is the bile duct dilated?
9mm
