Gallstones

Question 1

What are gallstones?

Answer 1

They are defined as a condition in which there is formation of stones within the gallbladder

These stones consist of hardened deposits of digestive fluid

Question 2

What two materials do gallstones usually consist of?

Answer 2

Cholesterol

Bilirubin

Question 3

What is the term used to refer to gallstones that consist of bilirubin?

Answer 3

Pigment gallstones

Question 4

What are the twelve risk factors associated with gallstones?

Answer 4

Older Age > 40

Female Gender

Family History

Obesity

Pregnancy

Liver Cirrhosis

Primary Sclerosing Cholangitis

Crohn’s Disease

Irritable Bowel Syndrome

Diabetes Mellitus

Sudden Weight Loss

Drug Administration

Question 5

What five drugs are associated with gallstones?

Answer 5

Combined contraceptive pill

Hormone replacement therapy

Ceftriaxone

Fenofibrate

Cholestyramine

Question 6

What pneumonic can be used to remember the main risk factors of gallstones?

Answer 6

5 Fs

Fat

Female

Fertile

Forty

Fair

Question 7

In general, when how gallstones present?

Answer 7

Asymptomatically

They become symptomatic obstruction of the bile ducts has occurred (biliary colic)

Question 8

What are the six clinical features of gallstones?

Answer 8

Colicky Right Upper Quadrant Pain

Jaundice

Diarrhoea

Fever

Nausea & Vomiting

Tachycardia

Question 9

What usually worsens the right upper quadrant pain associated with gallstones? What term is used to describe this?

Answer 9

Fatty foods

Postprandial

Question 10

What are the three investigations used to diagnose gallstones?

Answer 10

Blood Tests

Ultrasound Scan

Magnetic Resonance Cholangiopancreatography (MRCP)

Question 11

What are the five blood test results indicative of gallstones?

Answer 11

Increased AST Levels

Increased ALT Levels

Increased ALP Levels

Increased Bilirubin Levels

Increased Cholesterol Levels

Question 12

What is the gold standard investigation used to diagnose gallstones?

Answer 12

Ultrasound scan

Question 13

What are the two features of gallstones on ultrasound scans?

Answer 13

Echogenic Lesions

Rolling Stone Sign

Question 14

What is the rolling stone sign?

Answer 14

It is when a change of patient position causes gravity dependent movement of the stone

Question 15

What is MRCP?

Answer 15

It is a specialised MRI scan that produces detailed images of the hepatobiliary and pancreatic systems

Question 16

When are MRCPs used to investigate gallstones?

Answer 16

Those who present with a suggestive history of gallstones, however, produce negative ultrasound scan results

Question 17

When is management of gallstones recommended?

Answer 17

In cases of asymptomatic gallstones within the gallbladder, management options are not required

However, in cases where the asymptomatic gallstones are present within the common bile duct there is an increased complication risk and therefore management should be considered

Question 18

What is the pharmacological management option of gallstones?

Answer 18

Bile Acids

Question 19

Name a bile acid used to manage gallstones

Answer 19

Ursodeoxycholic acid (UDCA)

Question 20

How do bile acids manage gallstones?

Answer 20

They are used to regulate cholesterol levels and therefore dissolve cholesterol containing gallstones

Question 21

When are bile acids used to manage gallstones?

Answer 21

When individuals are unfit for surgery

Question 22

Why is pharmacological management of gallstones generally not recommended?

Answer 22

They are rarely effective

They require around two years of treatment to produce results

Question 23

In which two patient groups is UCDA contraindicated?

Answer 23

Pregnant

Breastfeeders

Question 24

What are the two surgical management options of gallstones?

Answer 24

Laparoscopic Cholecystectomy

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Question 25

What is the gold standard management option for gallstones?

Answer 25

Laparoscopic Cholecystectomy

Question 26

What is laparoscopic cholecystectomy?

Answer 26

It involves surgical removal of the gallbladder, following which bile will flow directly from the liver into the small bowel

Question 27

What incision is used in cholecystectomy?

Answer 27

Kocher’s

Question 28

When should laparoscopic cholecystectomy be conducted electively?

Answer 28

In cases where there are no features of acute cholecystitis

Question 29

When should laparoscopic cholecystectomy be conducted urgently?

Answer 29

In cases where there is development of acute cholecystitis

Question 30

What are the two complications associated with laparoscopic cholecystectomy?

Answer 30

Biliary leak

Gallstones in common bile duct

Question 31

What is the most common complication associated with laparoscopic cholecystectomy?

Answer 31

Biliary leak

Question 32

What are the two clinical features associated with biliary leak?

Answer 32

Right upper quadrant tenderness

Bilious fluid in the intra-abdominal drain

Question 33

What is ERCP?

Answer 33

It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum

In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken

Question 34

How is ERCP used to manage gallstones?

Answer 34

It can be used to remove gallstones from the bile duct

In some cases, a stent is then inserted into the bile duct to prevent reoccurrence

Question 35

What are the six complications associated with gallstones?

Answer 35

Biliary Colic

Acute Cholecystitis

Gallbladder Abscess

Ascending Cholangitis

Gallstone Ileus

Acute Pancreatitis

Question 36

What is biliary colic?

Answer 36

It occurs when the bile ducts become obstructed

Question 37

What five blood test results indicate biliary colic?

Answer 37

Normal ALP Levels

Normal AST Levels

Normal ALT Levels

Normal yGT Levels

Normal CRP Levels