gallstones Flashcards
(21 cards)
types of stones, prevelance and causes for each
- pigment <10% - haemolysis, stasis and infection
- cholesterol 90% - female, increasing age, obesity
- mixed
risk factors
obesity
female
increasing age
diabetes
family history
chronic loss of bile salts eg terminal ileal disease like crohns
combined oral contraceptive pill
pregnancy
rapid weight change
chronic haemolysis
mnemonic
fair
fat
female
forty
define
solid deposits
- cholesterol
- bilirubin
that form within the gallbladder
epidemiology
common
western
only 1-4% develop symptoms
aetiology
- Super-saturation of bile with cholesterol
- Gallbladder dysmotility leading to stasis
- Excessive bilirubin excretion
signs and symptoms
biliary colic - RUQ pain, worse after eating, no fever, neg murphys sign
acute cholecystitis - RUQ pain, radiating to right shoulder if diaphram irritated, fever, nausea, vomitting, + murphys sign
ascending cholangitis - RUQ pain, fever, jaundice, hypotension + confusion if sepsis severe
mirizzis syndrome - chronic RUQ pain + intermittent jaundice
chronic cholecystitis - flatulent, dyspepsia, vague abdominal pain, nausea, bloating, symptoms worsening after fatty meal, occasional colicky pain
gallstone ileus - small bowel obstruction
cholangiocarcinoma - abdominal pain, jaundice, anorexia, weight loss and possible RUQ mass
investigations
- raised LFT
- raised CRP
ultrasound - first line - detects bile duct dilation but less effective for mid/distal stones
ct - better detailed anatomy of biliary tree
MRCP - most accurate for detecting gallstones
ERCP - used for therapeutic intervention once aetiology confiromed
manageement
resuscitation:
IV fluids
antibiotics
critical care is needed
painkillers
avoid fat
biliary drainage:
- via ERCP, PTC or surgery
addressing underlying cause eg cholecystectomy for gallstones
biliary colic
- intermittent RUQ or epigastric pain
- gallbladder obstruction
- in cystic duct or gallbladder neck
- worse after eating
- no fever
- neg murphies sign
acute cholecytitis
- inflammation of gallbladder
- due to cystic duct obstruction by a gallstone
- leads to bile stasis and secondary infection
- RUQ pain radiating to right shoulder id diaphram irritated
- fever
- nausea
- vomitting
- positive murphys sign
ascending cholangitis
- life threatening infection of bile ducts due to biliary obstruction
- leads to spesis
- needs urgent treatment
- RUQ ppain
- fever
- jaundice
- hypotension
- confusion if sepsis severe
mirizzis syndrome
- rare complication of gallstones
- large stone in cystic duct or gallbladder neck compresses common hepatic duct
- leads to biliary obstruction and jaundice
- chronic RUQ pain
- intermittent jaundice
chronic cholecystitis
- chronic inflammation of gallbladder due to recurrent gallbladder obstruction and low grade irritation
- flatulent
- dyspepsia
- vague abdominal pain
- nausea
- bloating
- symptoms worsening after a fatty meal
- occasional colicky pain
gallstone ileus
- mechanical small bowel obstruction caused by gallstone entering the intestines
cholangiocarcinoma
- adenocarcinoma of bile ducts arising from intrahepatic perihilar or distal extrahepatic ducts
- abdominal pain
- jaundice
- anorexia
- weight loss
- possible RUQ pain
murphys sign
- ask patient to breathe out
- ask patient to breathe in deeplky
positive if:
- they stop bc painful
- you can palpitate inflamed gallbladder
Aetiology of gall stones (3)
- Cholesterol supersaturation (diet, hormones)
- Genetic (gallbladder motility)
- Haemoglobin turnover (haemolytic anaemia, cirrhosis, sickle cell)
10% of people have gallstones
And they acount for 30% of all acute presentations
bloods
- Alanine transaminase
- Bilirubin
- Amylase
Management of gall stones if not treating directly/straight away (4)
- NSAIDs for mild pain
- IM diclofenac for severe pain
- Change lifestyle
- Decrease fat in diet
What is it called when a gall stone is trapped in the common bile duct?
Choledocholelithiasis
another term for gallstones
biliary cholic
